1,720,986 research outputs found
Heart rate variability during sleep in children and adolescents with restless sleep disorder: a comparison with restless legs syndrome and normal controls
No full textStudy Objectives: Restless sleep disorder (RSD) has recently been characterized clinically and polysomnographically in children and differentiated from restless legs syndrome (RLS). Heart rate variability is a reliable method to quantify autonomic changes during sleep. The aim of this study was to characterize heart rate variability in children with RSD, RLS, and individuals without these disorders, with the hypothesis that children with RSD have a shift toward sympathetic predominance during sleep. Methods: We analyzed polysomnographic recordings from 32 children who fulfilled RSD diagnostic criteria (19 boys and 13 girls), 32 children with RLS (20 boys and 12 girls), and 33 individuals without disorders (17 boys and 16 girls). Four electrocardiographic epochs were chosen, 1 for each stage, and were analyzed for automatic detection of R waves. Time domain and frequency domain heart rate variability parameters were obtained and analyzed. Results: In terms of time domain, only the standard deviation of the average interval between successive R waves during stage N3 was slightly but significantly higher in patients with RSD than in patients with RLS. In terms of frequency domain, in patients with RSD, the very-low-frequency and low-frequency bands were increased (vs patients with RLS and individuals without disorders, respectively), whereas low-frequency/high-frequency ratio tended to be increased in both patients with RSD and with RLS. In rapid eye movement sleep, low-frequency/high-frequency ratio was increased in both patients with RSD and with RLS. The low-frequency/high-frequency ratio increased in patients with RLS during quiet wakefulness preceding sleep. Conclusions: Children with RSD have increased sympathetic activation during sleep, particularly N3 and rapid eye movement sleep, compared with individuals without disorders but, as expected, not during wakefulness. Differently, children with RLS have sympathetic activation during relaxed wakefulness preceding sleep and during sleep
Neurological aspects of sleep medicine, how sleep evolves, and regulation of function
No full textSleep is not a static but rather is a dynamic state of being, involving variations in cerebral blood flow, neurotransmitters, immune response, and metabolic changes, among others. The maturation and development of the human brain involves changes across the life span, in particular changes from childhood to adulthood. The brain structure and function develop, neuronal networks strengthen, and neurotransmitter signaling is modulated in different ways affecting sleep and wakefulness. The most conspicuous changes in sleep architecture during infancy and early childhood include fundamental parameters studied in sleep medicine: decrease in total sleep time, gradual consolidation of periods of sleep at night or wakefulness during the day hours, decrease in the intensity of (EEG power) of NREM sleep stage 3 slow-wave activity (SWA), and a steady decline in the percentage of time spent in REM sleep. Furthermore, the control of sleep, including the two-process model (the circadian and homeostatic processes), also undergoes significant changes from childhood to adulthood. In this chapter we discuss these changes and processes especially important to help patients during the transition from childhood to adolescence and adulthood
Treatment of pediatric restless legs syndrome
No full textRestless legs syndrome (RLS) is not uncommon in children with an estimated prevalence of 2%. There is clear evidence that RLS affects quality of life, sleep, cognition and behavior in children and adults. Although the diagnosis of RLS can be challenging in young children, the International Restless Legs Study Group (IRLSSG) has published guidelines for diagnosis which include description of symptoms in the child's own words. Once the diagnosis is made, treatment options must be explored. It is commonly accepted that non-pharmacological interventions be recommended to all affected families. These include maintaining a consistent bedtime routine, establishing healthy eating habits and exercise, avoiding caffeine and other substances that can exacerbate RLS, and stretching before bedtime. Pharmacological interventions in children are challenged by the lack of solid data supporting effectiveness and long-term safety. Historically and based on pathophysiology, iron supplementation is the first line therapy in children. Recently intravenous iron supplementation has shown promising results, following studies in adults. Most studies in children on various pharmacological options follow a robust body of data previously published in adult patient with RLS, yet data in children remain scarce. This chapter will discuss both non-pharmacologic and pharmacologic treatment options for children with RLS
Restless Legs Syndrome and Restless Sleep Disorder in Children
No full textRestless legs syndrome (RLS) affects 2% of children presenting with symptoms of insomnia, restless sleep, decreased quality of life, and effects on cognition and behavior. The International RLS Study Group and the American Academy of Sleep Medicine have published guidelines for the diagnosis and treatment of RLS in children. Restless sleep disorder has been recently identified in children and presents with frequent movements during sleep and daytime symptoms with polysomnography findings of at least 5 large muscle movements at night. Treatment options for both disorders include iron supplementation, either oral or intravenous with improvement in nighttime and daytime symptoms
The Parasomnias
No full textParasomnias usually present in childhood and resolve spontaneously. The diagnosis of non–rapid eye movement–related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement–related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated
Periodic limb movement disorder
No full textPeriodic limb movement disorder (PLMD) is characterized an elevated number of periodic leg movements during sleep (PLMS) and nighttime or daytime symptoms not explained by the presence of other comorbidities. The accurate assessment of the prevalence and significance of PLMD is therefore clouded by the high number of comorbidities and medications that exacerbate or precipitate PLMS, such as antidopaminergics, antidepressants and antihistaminergics or kidney disease, heart disease and iron deficiency anemia. Due to the difficulty in identification of these patients, a wide variety of prevalence of PLMD in both adults and children has been reported. Furthermore, since the diagnosis of PLMD requires a PSG (not required by the diagnostic criteria of many other sleep disorders), its true prevalence remains unknown. Treatment options for PLMD include the same options than for patients with restless legs syndrome, oral or intravenous iron supplementation, dopamine agonists, gabapentin, opiods and, to a lesser extent, benzodiazepines. More research is needed in the area of PLMD, in both adults and children, to assess prevalence, natural progression of the disorder and consequences of untreated PLMD
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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