Sympathoadrenal activity and sleep: in the search for a marker of hyperarousal in insomnia

Objective. To assess subjective and objective sleep characteristics and urinary metanephrine levels in patients with insomnia. Design and methods. We included patients with insomnia complaints and those without sleep– related complaints (control group) 18–75 years old. Subjective evaluation of the main sleep characteristics during the last month was assessed by the Pittsburgh Sleep Quality questionnaire, daytime sleepiness — by the Epworth Sleepiness Scale. For objective sleep evaluation we performed one-night polysomnography (PSG). Within 1 week after the PSG, daily urine was collected to determine the level of metaepinephrine. Results. The groups did not differ by age, mean sleep duration over the past month, number of night awakenings by the Pittsburgh Questionnaire, and level of daytime sleepiness. Sleep latency in insomnia group was 15 minutes longer than in the control group. PSG showed higher apnea-hypopnea and desaturation indices in the control group. There were no differences in daily urinary metanephrine excretion in the main and control groups. Correlation analysis showed no significant association between the metanephrine levels and the severity of somnolence and the index of periodic limb movements. Conclusions. Our analysis showed no significant differences in the daily urine metanephrine levels and the main PSG sleep characteristics among subjects with and without insomnia. Further work is required to clarify markers of insomnia and their negative health effects.

Hypersomnias and Sleep-Related Movement Disorders

Hypersomnias are disorders associated with excessive daytime sleepiness not related to sleep deprivation, disturbed nocturnal sleep, circadian rhythm disturbances, sleep-related breathing disorders, or a medical condition. This chapter reviews the primary hypersomnias of narcolepsy and idiopathic hypersomnia. Sleep-related movement disorders, including restless legs syndrome and periodic limb movements of sleep, are also commonly encountered in clinical practice. These common syndromes are reviewed in this chapter.

Incidence of ischemic stroke in patients with periodic limb movements in sleep: one-year follow-up

Objective. To assess the influence of periodic limb movements in sleep on the incidence of acute cardiovascular events. Design and methods. Fifty-six participants aged 60–75 years were included in the study. Eligibility criteria included no history of acute cardiovascular events and the presence of 1 or more risk factors for cardiovascular diseases. Nocturnal actigraphy and cardiorespiratory monitoring were performed. Patients with apnea/hypopnea index > 5/h were excluded (n = 6). Based on periodic limb movements index (PLMI) two groups were formed: main (PLMI ≥ 15/h, n = 26) and controls (PLMI < 15/h, n = 24). The groups were prospectively observed during 1 year. The endpoints of the study were cases of acute cardiovascular events. Results. Despite the similar prevalence of common risk factors for cardiovascular diseases in two groups, the patients with PLMI ≥ 15/h have a higher incidence of ischemic stroke within 1 year (odds ratio 1,07). Conclusions. Elevated PLMI might be regarded as a potential predictor for higher risk for ischemic stroke. Nevertheless, further investigations in the field are needed.

O022 Long-term cardiovascular risk in obstructive sleep apnoea: a sleep clinic cohort study

The relationship between obstructive sleep apnoea (OSA) and the development of long-term cardiovascular disease (CVD) is incompletely understood. We therefore investigated the impact of OSA severity, assessed by polysomnographic (PSG) metrics, on the development of long-term CVD in a sleep clinic cohort. Participants in the Western Australian Sleep Health Study, who attended a sleep clinic at a tertiary hospital between 2006 and 2010, were linked to state health administrative data from 1969 to 2016. Cox regression was used to investigate associations between standard PSG metrics of OSA severity (including the apnoea-hypopnoea index [AHI], time with oxygen saturation &lt;90% [T90], and arousal index) and a CVD composite outcome (hospitalisation due to coronary heart disease, heart failure, stroke, or atrial fibrillation), controlling for baseline CVD risk factors such as age, sex, and body mass index (BMI). A total of 4067 participants were included: mean (SD) age of 50.6 (14.0) years, with 60.8% men. The mean BMI was 32.7 (7.7) kg/m². Over a median follow-up of 7.3 years, 584 (14.4%) participants developed the composite CVD outcome. Following adjustment for risk factors, independent predictors of incident CVD were an AHI ≥30 events/hour (hazard ratio [HR], 1.21; 95% CI, 1.02–1.45), log (T90 + 1) (HR, 1.16; 95% CI, 1.03–1.31), and the periodic limb movements of sleep index (PLMSI) (HR, 1.01; 95% CI, 1.00–1.01). We demonstrated independent effects of AHI, hypoxaemia, and PLMSI on incident CVD in this large sleep clinic cohort, suggesting multi-faceted aspects of disrupted sleep influence cardiovascular risk in OSA.

Periodic Limb Movements Syndrome in Patients With Cerebral Small Vessel Disease: Protocol for a Prospective Observational Study

Background: Cerebrovascular diseases are the leading cause of cognitive decline and dementia. Therefore, the investigation of the potential ways to slow down the disease progression is an important research field. Periodic limb movements in sleep (PLMS) are known to be associated with transient changes in heart rate and blood pressure. These changes might influence the course of cerebral small vessel disease (cSVD). Nevertheless, the clinical significance of PLMS, particularly its influence on cardiovascular diseases course, is still controversial and underinvestigated.Methods/design: Patients from 60 to 75 years old diagnosed with cSVD will undergo nocturnal polysomnography. Subjects with apnea/hypopnea index under 5 will be enrolled. Sleep quality and daytime functioning will be assessed at baseline with self-reported questionnaires. Brain MRI and cognitive assessment will be performed at baseline and in the 2-year follow-up. Progression of cSVD markers and cognitive dysfunction will be compared between patients with PLMS index (PLMI) equal to or more than 15 movements per hour of sleep and controls (PLMI &lt;15/h).Discussion: The negative role of PLMS in cSVD progression and related cognitive decline is expected. We suppose that patients with PLMS tend to worsen in cognitive performance more rapidly than age-, gender-, and comorbidity-matched controls. We also expect them to have more rapid white matter hyperintensities and other cSVD marker progression. The limitations of the study protocol are the short follow-up period, the absence of a treatment group, and inability to make a conclusion about causality.

Case report of restless anal syndrome as restless legs syndrome variant after COVID-19

Background Coronavirus disease 2019 (COVID-19) has a broad spectrum from respiratory and nasopharyngeal symptoms, cerebrovascular diseases, impaired consciousness, and skeletal muscle injury. Emerging evidence has indicated the neural spread of this novel coronavirus. Restless legs syndrome (RLS) is a common neurological, sensorimotor disorder, but highly under diagnosis disorder. Restless anal syndrome as restless legs syndrome variant associated with COVID-19 has been previously not published. We report a case presenting with restless anal syndrome following COVID-19. Case presentation Although a 77-year-old male with COVID-19 improved to normal respiratory function 21 days after admission and treatment of favipiravir 200 mg per day for 14 days and dexamethasone 6.6 mg per day for 5 days, the insomnia and anxiety symptoms remained. Several weeks after discharge, he gradually began to experience restless, deep anal discomfort, approximately 10 cm from the perineal region. The following features were observed in the anal region; urge to move is essential, with worsening with rest, improvement with exercise, and worsening at evening. Colonoscopy revealed internal haemorrhoids without other rectal lesions. Neurological findings including deep tendon reflex, perineum loss of sensory and spinal cord injury, revealed no abnormalities. Diabetes militias, kidney dysfunction and iron deficiency status were not confirmed. Family history of RLS and periodic limb movements were not observed. Clonazepam at 1.5 mg per day resulted in the alleviation restless anal discomfort. Conclusions We reported a case presenting with restless anal syndrome following affection of COVID-19 as restless legs syndrome variant. This case fulfilled 4 essential features of RLS, urge to move, worsening with rest, improvement with exercise, and worsening at evening. To date, no case of restless anal syndrome associated with COVID-19 has been previously published. This case report may reflect the associative impacts of COVID-19 on the neuropsychiatric state. The long-term outcomes of neuropsychiatric conditions should continue to be monitored.