scholarly journals Effect of Eszopiclone on Sleep Disturbances and Daytime Fatigue in Multiple Sclerosis Patients

2011 ◽  
Vol 13 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Hrayr Attarian ◽  
Garrick Applebee ◽  
Angela Applebee ◽  
BingXia Wang ◽  
Melissa Clark ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Pilot Trial ◽  
Sleep Onset ◽  
Sleep Onset Latency ◽  
Double Blind ◽  
End Point ◽  
Multiple Sclerosis Patients ◽  
The Impact

The prevalence of moderate-to-severe sleep problems is significantly higher among people with multiple sclerosis (MS) than in the general population. In 2002, we found a significant relationship between fatigue and disrupted sleep in patients with relapsing-remitting MS (RRMS). The objectives of this study were to determine whether eszopiclone (Lunesta; Sunovion Pharmaceuticals Inc, Marlborough, MA) was superior to placebo in improving sleep among patients with MS-related fatigue and sleep complaints (primary end point); and to assess the impact of improved sleep on daytime fatigue and functioning (secondary end point). This was a double-blind, placebo-controlled pilot trial lasting 7 weeks. Thirty ambulatory adults under age 65 years with RRMS, fatigue, and sleep disturbances were randomized to receive either eszopiclone or placebo. The outcome measures included subjective and objective changes in sleep-onset latency (SOL), total sleep time (TST), wakefulness after sleep onset (WASO), sleep efficiency (SE), fatigue scales, and neuropsychological measures of daytime functioning. Compared with placebo, eszopiclone was superior only in increasing TST. Fatigue improved in both groups, but there was no statistically significant correlation between increased TST and improved fatigue, and no statistically significant differences were observed between the two groups. Thus, in this study, eszopiclone did not improve sleep sufficiently to improve fatigue in MS patients. This result may be due to the multifactorial nature of sleep disturbances and fatigue in people with MS.

Comorbidity of ADHD and Anxiety Disorders in School-Age Children: Impact on Sleep and Response to a Cognitive-Behavioral Treatment

2015 ◽  
Vol 22 (5) ◽  
pp. 414-424 ◽  
Author(s):  
Maxime Bériault ◽  
Lyse Turgeon ◽  
Mélanie Labrosse ◽  
Claude Berthiaume ◽  
Martine Verreault ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Sleep Disturbances ◽  
Behavioral Treatment ◽  
Sleep Onset ◽  
Cognitive Behavioral ◽  
Sleep Onset Latency ◽  
Sleep Habits ◽  
Children With Adhd ◽  
Comorbid Anxiety ◽  
The Impact

Objective: This exploratory study measured the impact of comorbid anxiety disorders on sleep in children with ADHD and tested the effect of cognitive-behavioral therapy (CBT) on these measures. Method: Fifty-seven children (8-12 years old) were assessed with the Child Sleep Habits Questionnaire. Four groups were formed: ADHD ( n = 20), ADHD + Anxiety ( n = 20), Anxiety ( n = 8), and Healthy Controls ( n = 9). A subgroup of 10 children with ADHD + Anxiety underwent CBT for anxiety. Results: The results showed that sleep difficulties were better associated with anxiety than with ADHD. CBT reduced sleep onset latency and marginally decreased the total amount of sleep problems. Conclusion: The present study demonstrates that comorbid anxiety in ADHD children is linked with specific sleep disturbances and is sensitive to CBT aimed at reducing anxiety.

Anxiety, Obsessive-Compulsive, and Related Disorders

2020 ◽  
pp. 318-336
Author(s):  
Bruce Rohrs ◽  
Benjamen Gangewere ◽  
Alicia Kaplan ◽  
Amit Chopra
Keyword(s):  
Anxiety Disorders ◽  
Sleep Disturbance ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Limited Evidence ◽  
Obsessive Compulsive ◽  
Psychotherapeutic Interventions

Despite its common comorbidity, sleep disturbance is often underrecognized and undertreated in individuals with anxiety disorders. Compared to mood disorders, sleep disturbance in this population is less well studied except for panic disorder and generalized anxiety disorder. Some evidence suggests a bidirectional link between anxiety disorders and sleep disturbance. Polysomnography findings point to some commonalities across anxiety disorders, including longer sleep onset latency, reduced total sleep time, and reduced sleep efficiency. The underlying biological mechanisms linking anxiety disorders and sleep disturbance are still unclear. However, there is limited evidence suggesting a connection between impaired executive functioning due to sleep problems and failure to inhibit anxiety related thoughts and feelings. Cortisol irregularities and disruption in the serotonergic system may also play a role. Evidence suggests that anxiety sensitivity is a transdiagnostic factor that contributes to both anxiety disorders and sleep disturbance. Further research is warranted to elucidate common biological and psychological factors underlying sleep disturbances and anxiety disorders. There is an imminent need to systematically assess the impact of sleep disturbance on symptom severity and treatment outcomes in anxiety, obsessive-compulsive, and related disorders. Limited evidence is available for medications and targeted psychotherapeutic interventions for management of sleep disturbance thus warranting the development of robust sleep interventions to achieve optimal clinical outcomes in this patient population.

scholarly journals Actigraphy-Derived Sleep Profiles of Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD) over Two Weeks—Comparison, Precursor Symptoms, and the Chronotype

2021 ◽  
Vol 11 (12) ◽  
pp. 1564
Author(s):  
Mirjam Ziegler ◽  
Anna Kaiser ◽  
Christine Igel ◽  
Julia Geissler ◽  
Konstantin Mechler ◽  
...  
Keyword(s):  
Sleep Disturbances ◽  
Sleep Problems ◽  
Neuropsychological Functioning ◽  
Sleep Onset ◽  
Onset Time ◽  
Individual Variability ◽  
Sleep Onset Latency ◽  
Neurocognitive Performance ◽  
Children With Adhd ◽  
Underlying Mechanisms

Although sleep problems are common in children with ADHD, their extent, preceding risk factors, and the association between neurocognitive performance and neurobiological processes in sleep and ADHD, are still largely unknown. We examined sleep variables in school-aged children with ADHD, addressing their intra-individual variability (IIV) and considering potential precursor symptoms as well as the chronotype. Additionally, in a subgroup of our sample, we investigated associations with neurobehavioral functioning (n = 44). A total of 57 children (6–12 years) with (n = 24) and without ADHD (n = 33) were recruited in one center of the large ESCAlife study to wear actigraphs for two weeks. Actigraphy-derived dependent variables, including IIV, were analyzed using linear mixed models in order to find differences between the groups. A stepwise regression model was used to investigate neuropsychological function. Overall, children with ADHD showed longer sleep onset latency (SOL), higher IIV in SOL, more movements during sleep, lower sleep efficiency, and a slightly larger sleep deficit on school days compared with free days. No group differences were observed for chronotype or sleep onset time. Sleep problems in infancy predicted later SOL and the total number of movements during sleep in children with and without ADHD. No additional effect of sleep problems, beyond ADHD symptom severity, on neuropsychological functioning was found. This study highlights the importance of screening children with ADHD for current and early childhood sleep disturbances in order to prevent long-term sleep problems and offer individualized treatments. Future studies with larger sample sizes should examine possible biological markers to improve our understanding of the underlying mechanisms.

scholarly journals 0486 Impact of Intrinsic Factors on Efficacy of Lemborexant: Subgroup Analyses of SUNRISE-2

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A186-A187
Author(s):  
M Moline ◽  
Y Inoue ◽  
N Kubota ◽  
K Pinner ◽  
C Perdomo ◽  
...  
Keyword(s):  
Sleep Onset ◽  
Sleep Diary ◽  
Sleep Onset Latency ◽  
Double Blind ◽  
Intrinsic Factors ◽  
Insomnia Disorder ◽  
Patient Reported ◽  
Full Analysis ◽  
The Impact ◽  
Patient Subgroups

Abstract Introduction Lemborexant (LEM), a dual orexin receptor antagonist, demonstrated significant benefits vs placebo on patient-reported sleep outcomes in adults age ≥18y in SUNRISE-2 (NCT02952820; E2006-G000-303). The impact of intrinsic factors (sex, race, and region) on LEM efficacy outcomes was assessed. Methods SUNRISE-2 was a randomized, double-blind, global phase 3 study in adults age ≥18y with insomnia disorder (Full Analysis Set, n=949). Subjects received placebo (n=318) or LEM (5mg [LEM5], n=316; 10mg [LEM10]; n=315) for 6 months. At 6 months, placebo subjects were rerandomized to LEM for another 6 months (not reported here); LEM subjects remained on their assigned dose. Sleep diary-based (subjective) sleep onset latency (sSOL) and wake after sleep onset (sWASO) were assessed for prespecified patient subgroups including: sex (male [n=302], female [n=647]), race (white [n=679], black [n=76], Asian [n=178]), and region (North America [n=302], Europe/New Zealand [n=483], Asia [n=164]). Analyses were not controlled for multiplicity. Results LEM5 and LEM10 provided numerically greater median reductions (improvement) from baseline in sSOL vs placebo at 6 months in across all subgroups examined. Also, LEM5 and LEM10 led to mean reductions (improvement) from baseline at 6 months in sWASO for all subgroups. While several subgroups had small numbers of subjects, changes from baseline in sSOL and sWASO were in the direction of improvement in the majority of subgroups. Pharmacokinetic analyses showed no important differences in exposure by these factors. Conclusion LEM treatment demonstrated efficacy in improving sSOL and sWASO across patient subgroups, supporting common dosing instructions for both sexes and all races. Support Eisai Inc.

Examining sleep, fatigue, and daytime sleepiness in pediatric multiple sclerosis patients

2011 ◽  
Vol 18 (4) ◽  
pp. 481-488 ◽  
Author(s):  
Abu-Bakar Zafar ◽  
Jayne Ness ◽  
Sarah Dowdy ◽  
Kristin Avis ◽  
Khurram Bashir
Keyword(s):  
Multiple Sclerosis ◽  
Sleep Quality ◽  
Daytime Sleepiness ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Sleep Hygiene ◽  
Control Group ◽  
Stability Dimension ◽  
Multiple Sclerosis Patients ◽  
Historical Controls

Background: About 2–5% of patients with multiple sclerosis (MS) experience their first symptoms before age 18. Sleep disorders occur frequently in MS. The prevalence of sleep problems and their impact on fatigue and daytime sleepiness in pediatric MS is unknown. Objective: To determine whether pediatric MS patients have more sleep disturbances, fatigue, and daytime sleepiness compared with an age-, sex-, and race-matched control group. Methods: Patients and age-, sex-, and race-matched controls were surveyed to quantify daytime sleepiness via the modified Epworth Sleepiness Scale, sleep quality and hygiene through the Adolescent Sleep Wake and Hygiene Scale, respectively, and fatigue using the PediatricQL Multidimensional Fatigue Scale. Results: Pediatric MS patients ( n = 30) and age-, sex-, and race-matched controls ( n = 52) had similar levels of fatigue; however, when compared with previously published historical controls, both groups reported worse fatigue across all dimensions ( p < 0.05). Pediatric MS patients also had similar sleep quality compared with the matched controls, but reported better sleep hygiene on the ‘sleep stability’ dimension ( p < 0.05). In addition, pediatric MS patients had less daytime sleepiness than the matched controls ( p < 0.05). Conclusion: Although patients with MS reported similar levels of fatigue, they have better sleep hygiene, which could possibly account for the decreased amount of excessive daytime sleepiness. Also, when compared with historical controls, the MS and control samples reported more fatigue. Thus, caution must be taken when using published control data, especially when not properly matched.

scholarly journals JC Virus Seroprevalence and JCVAb Index in Polish Multiple Sclerosis Patients Treated with Immunomodulating or Immunosuppressive Therapies

2021 ◽  
Vol 10 (9) ◽  
pp. 1998
Author(s):  
Robert Bonek ◽  
Wojciech Guenter ◽  
Robert Jałowiński ◽  
Anna Karbicka ◽  
Anna Litwin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Jc Virus ◽  
Dimethyl Fumarate ◽  
Risk Category ◽  
Seroprevalence Rate ◽  
Immunomodulatory Drugs ◽  
Cross Sectional ◽  
Treatment Type ◽  
Multiple Sclerosis Patients ◽  
The Impact

The use of a highly-effective treatment for multiple sclerosis (MS) is associated with a severe risk of developing complications, such as progressive multifocal leukoencephalopathy (PML) caused by the John Cunningham virus (JCV). The aim of this study was to evaluate the correlation between anti-JCV Ab seroprevalence, anti-JCV AI, demographic and clinical factors as well as the type of therapy used in the Polish MS population. This is a multicentre, prospective and cross-sectional study involving 1405 MS patients. The seroprevalence of anti-JCV Ab and anti-JCV AI levels as well as AI categories were analysed with the use of a second-generation two-step ELISA test (STRATIFY JCV DxSelect). The overall prevalence of anti-JCV Ab was 65.8%. It was shown that seroprevalence increases with the patient’s age. The seroprevalence was significantly associated with the treatment type, and the highest values (76%) were obtained from immunosuppressant-treated patients. Overall, 63.3% of seropositive patients had an antibody index (AI) level of >1.5. In the seropositive patient group, the mean AI level amounted to 2.09. Similarly to the seroprevalence, AI levels correlated with the patient’s age; AI level for patients above 40 years old and from subsequent age quintiles plateaued, amounting to at least 1.55. Patients treated with immunosuppressants and immunomodulatory drugs obtained the highest (1.67) and lowest (1.35) AI levels, respectively. Of the immunosuppressants used, the highest mean AI levels were observed in mitoxantrone and cladribine groups, amounting to 1.75 and 1.69, respectively. In patients treated with immunomodulatory drugs, the lowest AI levels were observed in the dimethyl fumarate (DMF) group (1.11). The seroprevalence rate in the Polish MS population is one of the highest in Europe. The majority of seropositive patients had an anti-JCV Ab level qualifying them for a high-risk category. The highest mean AI levels are observed in patients receiving immunosuppressants, especially mitoxantrone and cladribine. Patients receiving immunomodulatory drugs have lower AI levels compared to treatment-naïve subjects, especially when treated with DMF. Further studies, especially longitudinal studies, are required to determine the impact of MS drugs on the seroprevalence of anti-JCV Ab and AI levels.

scholarly journals Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial

2021 ◽  
Author(s):  
Bente Storm Mowatt Haugland ◽  
Mari Hysing ◽  
Asle Hoffart ◽  
Åshild Tellefsen Haaland ◽  
Jon Fauskanger Bjaastad ◽  
...  
Keyword(s):  
Early Intervention ◽  
Standard Length ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Sleep Onset Latency ◽  
Post Intervention ◽  
Clinical Trial Registration

AbstractThe potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p <  0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251, Date: 11.31. 2014

scholarly journals Regulation of CTLA-4 and PD-L1 Expression in Relapsing-Remitting Multiple Sclerosis Patients after Treatment with Fingolimod, IFNβ-1α, Glatiramer Acetate, and Dimethyl Fumarate Drugs

2021 ◽  
Vol 11 (8) ◽  
pp. 721
Author(s):  
Afshin Derakhshani ◽  
Zahra Asadzadeh ◽  
Hossein Safarpour ◽  
Patrizia Leone ◽  
Mahdi Abdoli Shadbad ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Mononuclear Cells ◽  
Demyelinating Disease ◽  
Immune Checkpoints ◽  
Peripheral Blood Mononuclear ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Multiple Sclerosis Patients ◽  
Relapsing Remitting Multiple Sclerosis ◽  
The Impact

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system (CNS) that is characterized by inflammation which typically results in significant impairment in most patients. Immune checkpoints act as co-stimulatory and co-inhibitory molecules and play a fundamental role in keeping the equilibrium of the immune system. Cytotoxic T-lymphocyte antigen-4 (CTLA-4) and Programmed death-ligand 1 (PD-L1), as inhibitory immune checkpoints, participate in terminating the development of numerous autoimmune diseases, including MS. We assessed the CTLA-4 and PD-L1 gene expression in the different cell types of peripheral blood mononuclear cells of MS patients using single-cell RNA-seq data. Additionally, this study outlines how CTLA-4 and PD-L1 expression was altered in the PBMC samples of relapsing-remitting multiple sclerosis (RRMS) patients compared to the healthy group. Finally, it investigates the impact of various MS-related treatments in the CTLA-4 and PD-L1 expression to restrain autoreactive T cells and stop the development of MS autoimmunity.

scholarly journals 1142 Comprehensive Phenotyping Of Ambulatory Sleep Patterns In Multiple Sclerosis

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A435-A435
Author(s):  
T J Braley ◽  
A L Kratz ◽  
D Whibley ◽  
C Goldstein
Keyword(s):  
Multiple Sclerosis ◽  
Sleep Quality ◽  
Extreme Values ◽  
Sleep Onset ◽  
External Support ◽  
Poor Sleep ◽  
Sleep Patterns ◽  
Poor Sleep Quality ◽  
Historical Cohort ◽  
The Impact

Abstract Introduction The majority of sleep research in persons with multiple sclerosis (PwMS) has been siloed, restricted to evaluation of one or a few sleep measures in isolation. To fully characterize the impact of sleep disturbances in MS, multifaceted phenotyping of sleep is required. The objective of this study was to more comprehensively quantify sleep in PwMS, using a recently developed multi-domain framework of duration, continuity, regularity, sleepiness/alertness, and quality. Methods Data were derived from a parent study that examined associations between actigraphy and polysomnography-based measures of sleep and cognitive function in MS. Actigraphy was recorded in n=55 PwMS for 7-12 days (Actiwatch2®, Philips Respironics). Sleep metrics included: duration=mean total sleep time (TST, minutes); continuity=mean wake time after sleep onset (minutes), and regularity=stddev wake-up time (hours). ‘Extreme’ values for continuity/regularity were defined as the most extreme third of the distributions. ‘Extreme’ TST values were defined as the lowest or highest sixth of the distributions. Sleepiness (Epworth Sleepiness Scale score) and sleep quality [Pittsburgh Sleep Quality Index (PSQI) sleep quality item] were dichotomized by accepted cutoffs (&gt;10 and &gt;1, respectively). Results Sleep was recorded for a mean of 8.2 days (stddev=0.95). Median (1st, 3rd quartile) values were as follows: duration 459.79 (430.75, 490.60), continuity 37.00 (23.44, 52.57), regularity 1.02 (0.75, 1.32), sleepiness/alertness 8 (4, 12), and sleep quality 1.00 (1.00, 2.00). Extreme values based on data distributions were: short sleep &lt;=426.25 minutes (18%), long sleep &gt;515.5 minutes (16%), poor sleep continuity ≥45 minutes (33%), and poor sleep regularity ≥1.17 hours (33%). Sleepiness and poor sleep quality were present in 36% and 40% respectively. For comparison, in a historical cohort of non-MS patients, the extreme third of sleep regularity was a stddev of 0.75 hours, 13% had ESS of &gt;10, and 16% had poor sleep quality. Conclusion In this study of ambulatory sleep patterns in PwMS, we found greater irregularity of sleep-wake timing, and higher prevalence of sleepiness and poor sleep quality than published normative data. Efforts should be made to include these measures in the assessment of sleep-related contributions to MS outcomes. Support The authors received no external support for this work.

Sign in / Sign up

Export Citation Format

Share Document