1,721,257 research outputs found
The emergence of pediatric sleep medicine
No full textIn the following sections, we outline the development of pediatric sleep medicine. We first review the clinical picture, analyzing studies on insomnia, parasomnias, respiratory disturbances, narcolepsy, disorders of movements during sleep, and sudden infant death syndrome (SIDS). In the second part, we describe how the initial studies on infant and child sleep helped the discovery of rapid eye movement (REM) sleep and how sleep research led to the definition of sleep structure in newborns, infants, and children. The third part describes the fascinating stories of sleep researchers that made this process possible and that built the history of pediatric sleep medicine. The final section is devoted to the description of the birth of different pediatric sleep associations
Sleep and headache
No full textThe interaction between sleep and headache or migraine is powerful and an elevated comorbidity between these 2 disorders has been reported in either adults or children. This comobidity is linked to common neurophysiological and neuroanatomical substrates that are genetically based strongly. The first reports on this relationship were related to the prevalence of parasomnias and sleep-disordered breathing in headache but recent research has expanded the comorbidity to several other sleep disorders, such as restless legs syndrome, periodic limb movements during sleep, and narcolepsy. The assessment of children with headache should always include an accurate anamnesis for the presence of sleep problems either in the child or in the relatives; no correct approach for treating children and adolescents is possible without an integrated method of evaluation and managemen
Restless sleep disorder (RSD): a new sleep disorder in children. A rapid review
No full textPurpose of Review Restless sleep disorder (RSD) is a recently identified pediatric sleep disorder characterized by frequent movements during sleep associated with daytime symptoms. In this review we summarize the expanding evidence of the clinical presentation of RSD, potential pathophysiology, associated comorbidities, and current treatment options that will help the pediatrician identify children with RSD in a timely manner. Recent Findings RSD is diagnosed in 7.7% of children referred evaluated in a pediatric sleep center. Children with RSD present with frequent nightly movements during sleep for at least 3 months, and have daytime symptoms related to poor sleep quality including excessive sleepiness, hyperactivity, irritability among other symptoms. Current evidence shows an increased sympathetic predominance, increased NREM sleep instability, and iron deficiency, as well as increased prevalence in parasomnias and attention deficit hyperactivity disorder. Consensus diagnostic criteria were recently published to diagnose RSD and emergent evidence suggests that iron supplementation improves its nighttime and daytime symptoms
Anxiety sensitivity in late-life depression. Links to cognitive impairment, insomnia, and health-related quality of life
No full textBackground and aims: Anxiety sensitivity (AS)-the fear of anxiety-related sensations driven by beliefs about their harmful consequences-is a well-established transdiagnostic vulnerability factor in younger and adult populations, but it has been less studied in late-life depression. This study investigated AS in older adults with major depressive disorder. Methods: A total of 432 patients aged ≥60 years were evaluated for depressive symptoms (Montgomery-Åsberg Depression Rating Scale; Hamilton Depression Rating Scale), anxiety (Brief Symptom Inventory; Penn State Worry Questionnaire), cognition (Mini-Mental State Examination; Repeatable Battery for the Assessment of Neuropsychological Status; Delis-Kaplan Executive Function System), health-related quality of life (HRQOL: Medical Outcomes Study 36-item Short Form Health Survey; Cumulative Illness Rating Scale), and antidepressant-related side effects (Abnormal Involuntary Movement Scale; Barnes Akathisia Scale; Udvalg for Kliniske Undersøgelser scale). Anxiety Sensitivity Index was used to assess AS. Results: Patients with higher AS levels were more frequently women, had fewer education years, and exhibited greater depressive and anxiety severity, higher rates of panic disorder, poorer cognitive performance, worse physical HRQOL, and a higher burden of antidepressant side effects. Associations with insomnia were limited to the middle-of-the-night subtype. Limitations: The cross-sectional design and diagnostic constraints limit generalizability and causal inference. Conclusions: In older adults with major depression, moderate to high AS levels correlate with cognitive, clinical, and functional vulnerability. These findings support the role of anxiety sensitivity as a prognostic marker in late-life depression
Decreased sleep stage transition pattern complexity in narcolepsy type 1
No full textObjective To analyze the complexity of the nocturnal sleep stage sequence in central disorders of hypersomnolence (CDH), with the hypothesis that narcolepsy type 1 (NT1) might exhibit distinctive sleep stage sequence organization and complexity. Methods Seventy-nine NT1 patients, 22 narcolepsy type 2 (NT2), 22 idiopathic hypersomnia (IH), and 52 patients with subjective hypersomnolence (sHS) were recruited and their nocturnal sleep was polysomnographically recorded and scored. Group between-stage transition probability matrices were obtained and compared. Results Patients with NT1 differed significantly from all the other patient groups, the latter, in turn, were not different between each other. The individual probability of the R-to-N2 transition was found to be the parameter showing the difference of highest significance between the groups (lowest in NT1) and classified patients with or without NT1 with an accuracy of 78.9% (sensitivity 78.5% and specificity 79.2%), by applying a cut-off value of 0.15. Conclusions The main result of this study is that the structure of the sleep stage transition pattern of hypocretin-deficient NT1 patients is significantly different from that of other forms of CDH and sHS, with normal hypocretin levels. Significance The lower probability of R-to-N2 transition occurrence in NT1 appears to be a reliable polysomnographic feature with potential application at the individual level, for supportive diagnostic purposes
Leg kicking and rubbing as a highly suggestive sign of pediatric restless legs syndrome
No full textRestless legs syndrome (RLS) is a common pediatric neurologic condition affecting 2–4% of children and adolescents [1] with significant impact on sleep and health [2]. Early manifestations of RLS, such as disorders of initiating and maintaining sleep, have been described by Picchietti et al. [3] but the diagnosis in infants is difficult due to their poor language skills.
Revised and simplified diagnostic criteria for pediatric RLS specifically indicate that “the description of these symptoms should be in the child’s own words.” For non-verbal children, “diagnosis by behavioral observation” is suggested [1], supported by homevideo-recording [4]
“Are new lipid lowering agents a good option for achieving lipid goals in people living with HIV? A case report”
No full textThe dyslipidemia in people living with HIV differs from the general population because combination antiretroviral therapy may not only induce dyslipidemia but also interact with lipid-lowering agents. Monoclonal antibodies that target proprotein convertase subtilisin/kexin type 9 (PCSK9) have recently been demonstrated to dramatically reduce LDL-C level (>60%) in the majority of cases, and another interesting new option is inclisiran, a firstin-class, cholesterol-lowering small interfering RNA (siRNA) targeting PCSK9 mRNA and conjugated to triantennary Nacetylgalactosamine carbohydrates (GalNAc). We present the clinical case of a 62-year-old man living with HIV and dyslipidemia in whom new hypolipidemic drugs were fundamental in achieving adequate LDL values to prevent cardiovascular events
Passive suicide ideation in major depressive disorder: prognostic role and effect of antidepressant treatment
No full textBackground and aims: Passive suicidal ideation (PSI)—defined as the desire to die without any intent to act—is a relatively understudied phenomenon. This study investigated its prognostic role in major depressive disorder (MDD) and its evolution during antidepressant treatment. Methods: A total of 482 outpatients (30 % male; mean age = 43.14 ± 12.46 years) from the CO-MED trial were included. Clinical evaluations were conducted at baseline and again after 6 weeks, assessing depressive and hypomanic symptoms, comorbid anxiety, and childhood trauma. PSI was measured using four targeted items from the Concise Health Risk Tracking Self-Report scale (CHRT_PSI; score range 0–16). To distinguish PSI from related depressive symptoms such as hopelessness, a conservative threshold (CHRT_PSI ≥5) was used when analyzing clinical features and treatment response. A broader, more sensitive threshold (CHRT_PSI ≥4) was applied when evaluating PSI's predictive accuracy for suicidal behavior. Results: Compared to patients without PSI, those in the PSI group (n = 283; 59 %) exhibited more severe depressive symptoms, higher rates of comorbid anxiety disorders, and more childhood traumas, including both physical and emotional abuse. While PSI showed modest overall accuracy (37 %–46 %) in predicting suicidal behavior, its sensitivity (66 %–85 %) and negative predictive value (78 %–89 %) were good. PSI was also a significant predictor of response to antidepressants, an effect that remained robust even after adjusting for age, sex, depression severity, and history of childhood maltreatment. Among the 270 PSI patients who completed 6 weeks of treatment, 96 achieved remission from PSI. Insomnia and anhedonia were associated with poorer outcomes, while talkativeness was linked to a higher likelihood of remission. Conclusion: PSI is common in individuals with MDD and is associated with a worse prognosis. Insomnia may act as a barrier to PSI remission during treatment
Sex-specific sleep disturbances worsen psychiatric symptoms and cognitive decline in individuals with Alzheimer's disease
No full text: BackgroundThe possible association between sleep disturbances, neuropsychiatric symptoms and progression of cognitive decline considering sex still need to be clarified.ObjectiveThe aims of the study were to evaluate the possible associations between disturbed sleep (DS) and neuropsychiatric symptoms (NPS) and to evaluate the possible association between DS, cognitive decline progression and caregiver burden focusing on sex-differences.Methods184 participants were collected within the CATIE-AD trial. Based on the response given by the caregiver to the Neuropsychiatric Inventory, patients were classified into AD with disturbed sleep (AD-DS) or AD without disturbed sleep (ADwDS). Cognitive performance and NPS were evaluated. Progression was evaluated with the Δ-Mini-Mental State Examination (MMSE) (baseline MMSE-MMSE at 3-month follow-up). A sex stratified analysis was carried out.ResultsAD-DS performed worse than participants with ADwDS at all the cognitive tests. AD-DS presented more frequently depression, anxiety, aberrant motor behavior, disinhibition and eating disorders. At the sex-stratified analysis, AD-DS women were more frequently disinhibited and depressed than ADwDS. Men with AD-DS presented worse performances at several cognitive tests. Furthermore, various NPS were more frequent in men with AD-DS than in those with ADwDS, including hallucination, agitation, depression, and aberrant motor behavior. The burden was higher in caregivers of men belonging to the AD-DS group. Finally, at the linear regression, adjusting for age, education and MMSE at baseline, the presence of disturbed sleep was related to a more evident decline in MMSE in men (coeff. 2.5; 95%CI 0.72-4.29; p-value 0.006).ConclusionsDS was associated with several NPS, caregiver burden and, in men, faster cognitive decline progression
Restless sleep disorder in children. A pilot study on a tentative new diagnostic category
No full textA group of children with "restless sleep" who do not fit the criteria for any other sleep disorder but with daytime impairment are studied to identify restless sleep disorder (RSD) clinically and polysomnographically and to differentiate it from other sleep disorders of childhood
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