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DelRosso LM, Mogavero MP, Ferri R. Restless sleep disorder, restless legs syndrome, and periodic limb movement disorder-Sleep in motion! Pediatr Pulmonol 2022; 57:1879-1886. [PMID: 33527761 DOI: 10.1002/ppul.25305] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 12/23/2022]
Abstract
Sleep-related movement disorders (SRMDs) represent an important part of pediatric sleep disorders. The most common complaint in SRMD is restless sleep at night. Restless sleep is reported in up to 80% of children with restless legs syndrome (RLS) and children with periodic limb movements of sleep (PLMS) disorder (PLMD). However, restless sleep causing daytime behavioral consequences can be seen in children without another apparent condition and has recently been identified as a new independent primary pediatric sleep disorder, called restless sleep disorder (RSD). This study describes these three main SRMDs (RSD, RLS, and PLMD), explains the new consensus criteria for RSD, emphasizes the rapidly evolving areas of research in this field, and proposes recommendations for future research. In particular, the published data constitute convincing evidence that sleep-related movements are disruptors of sleep quality and continuity. However, while important advancements have recently been reported in adults, a detailed analysis of the phenomenology and consequences of sleep-related movements has just started in children. New approaches, standardized diagnostic methods, and specific guidelines are needed in the field of pediatric SRMD.
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Affiliation(s)
| | - Maria P Mogavero
- Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Pavia, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
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DelRosso LM, Mogavero MP, Ferri R. Effect of Sleep Disorders on Blood Pressure and Hypertension in Children. Curr Hypertens Rep 2020; 22:88. [PMID: 32893326 DOI: 10.1007/s11906-020-01100-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW In this review, we aim to discuss the pathophysiologic basis of hypertension in sleep disorders and the current evidence in the medical literature linking sleep disorders and hypertension in children. RECENT FINDINGS The medical literature in adults is clear about the contribution of sleep disorders, poor sleep quality, and sleep deprivation to hypertension and increased cardiovascular risk. The literature on cardiovascular consequences of sleep disorders in children is not as robust, but there is some evidence of early cardiovascular changes in children with sleep deprivation and obstructive sleep apnea. Children with obstructive sleep apnea have increased sympathetic activation during sleep, blunted dipping, or elevated systolic or diastolic pressures. Although the literature on other sleep disorders such as narcolepsy and restless legs syndrome is scarce, there is evidence in adults and some recent supportive data in children.
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Affiliation(s)
- Lourdes M DelRosso
- Pediatric Pulmonary and Sleep Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Maria Paola Mogavero
- Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Via Salvatore Maugeri 4, 27100, Pavia, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute-IRCCS, Via C. Ruggero 73, 94018, Troina, Italy
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Determinants of Nocturnal Cardiovascular Variability and Heart Rate Arousal Response in Restless Legs Syndrome (RLS)/Periodic Limb Movements (PLMS). J Clin Med 2019; 8:jcm8101619. [PMID: 31590229 PMCID: PMC6832401 DOI: 10.3390/jcm8101619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/23/2022] Open
Abstract
Recent studies have suggested that restless legs syndrome is associated with an increased prevalence of cardiovascular diseases mediated by sympathetic activation occurring during periodic limb movements. The aim of this study was to establish which factors affect the degree of sympathetic activation during the basal condition and during periodic limb movements that may contribute to increased vascular risk. Fifty untreated restless legs syndrome patients aged 62.6 ± 11.1 y, free of cardiovascular diseases, were examined. Heart rate variability was calculated during wakefulness and all sleep stages, during periods with and without periodic limb movements. Heart rate changes before and after periodic limb movement onset were analyzed to assess the arousal response to periodic limb movements. Both analyses took into account the effects of age, gender, periodic limb movement duration, periodic limb movement index, periodic limb movement interval and periodicity, and magnitude of muscular activity (electromyogram power). Compared to periods without periodic limb movements, a significant increase in sympathetic activity occurred in periods with periodic limb movements, independent of age, sex and periodic limb movement characteristics. Data obtained from the cardiac arousal response to periodic limb movements showed that electromyogram power is the factor affecting sympathetic tonus. These results suggest that other factors, such as electromyogram power and individual susceptibility, should be considered in the assessment of the vascular risk related to restless legs syndrome.
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Dye TJ, Gurbani N, Simakajornboon N. How does one choose the correct pharmacotherapy for a pediatric patient with restless legs syndrome and periodic limb movement disorder?: Expert Guidance. Expert Opin Pharmacother 2019; 20:1535-1538. [DOI: 10.1080/14656566.2019.1629418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Thomas J. Dye
- Division of Pulmonary and sleep medicine, Cincinnati, OH, USA
- Division of neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Neepa Gurbani
- Division of Pulmonary and sleep medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Narong Simakajornboon
- Division of Pulmonary and sleep medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
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Night-time cardiac autonomic modulation as a function of sleep-wake stages is modified in otherwise healthy overweight adolescents. Sleep Med 2019; 64:30-36. [PMID: 31655323 DOI: 10.1016/j.sleep.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Even though sympathetic dominance during the daytime period is well known, currently, scarce data exist on autonomic nervous system (ANS) regulation during sleep in pediatric obesity. We aimed to evaluate sleep cardiac ANS regulation in normal-weight (NW) and overweight and obese (OW) adolescents. PATIENTS/METHODS In this study, 60 healthy adolescents (15.7 ± 0.7 years) belonging to a birth cohort since infancy were classified based on body mass index percentiles criteria as: OW (N = 27) or NW (N = 33). Sleep was evaluated by polysomnography (PSG) during two consecutive in-lab overnight sessions. Non-rapid eye movement (non-REM) sleep stages (stages 1, 2, and slow-wave sleep [SWS]), rapid eye movement (REM) sleep, and wakefulness (Wake) were scored. R-waves were detected automatically in the electrocardiographic (ECG) signal. An all-night heart rate variability analysis was conducted in the ECG signal, with several time- and frequency-domain measures calculated for each sleep-wake stage. Sleep time was divided into thirds (T1, T2, T3). The analysis was performed using a mixed-effects linear regression model. RESULTS Sleep organization was comparable except for reduced REM sleep percentage in the OW group (p < 0.04). Shorter R-R intervals were found for all sleep stages in the OW group; time-domain measured standard deviation of all R-R intervals (RRSD) was lower during stage 2, SWS and REM sleep (all p < 0.05). The square root of the mean of the sum of the squares of differences between adjacent R-R intervals (RMSSD) was also lower only during wake after sleep onset (WASO) in T1 and T3 (p < 0.05). The OW group had increased very low- and low-frequency (LF) power during WASO (in T1 and T2), and LF power during stage 2 and REM sleep (in T2). During WASO in the OW group, high-frequency (HF) power was lower (in T1 and T2), and LF/HF ratio was higher (in T2, p < 0.007). CONCLUSIONS Several sleep-stage-dependent changes in cardiac autonomic regulation characterized the OW group. As sleep-related ANS balance was disturbed in the absence of concomitant metabolic alterations in this sample of otherwise healthy OW adolescents, their relevance for pediatric obesity should be further explored throughout development.
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Xie J, Covassin N, Chahal AA, Schulte PJ, Singh P, Somers VK, Caples SM. Effect of Adaptive Servo-Ventilation on Periodic Limb Movements in Sleep in Patients With Heart Failure. Am J Cardiol 2019; 123:632-637. [PMID: 30554649 DOI: 10.1016/j.amjcard.2018.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/10/2018] [Accepted: 11/15/2018] [Indexed: 12/20/2022]
Abstract
Periodic limb movements in sleep (PLMS) are associated with adverse outcomes in patients with heart failure (HF). The aim of this study was to investigate whether PLMS change in response to adaptive servo-ventilation (ASV) for central sleep apnea (CSA) in patients with HF. We examined polysomnographic studies conducted between 2010 and 2014 at Mayo Clinic, Rochester, Minnesota (n = 14,444). In those, 314 of 579 patients with CSA completed the sleep study with a protocol that began with diagnostic polysomnography, followed by continuous positive airway pressure, and, for persistent CSA, by ASV titration. Patients with HF (n = 118) had a significantly higher median PLM index compared with those without HF (n = 196): 33.7 versus 6.1 events/h (p <0.001). HF was associated with a significant PLM arousal index (PLMAI) increase from diagnostic trial to ASV (odds ratio [OR] = 1.79, p = 0.032) after adjusting for demographics, co-morbidities and medications. In patients aged >68 years, HF was associated with PLMI and PLMAI increases during ASV (OR = 2.16, p = 0.016 and OR = 2.05, p = 0.024), which persisted in multivariable models (OR = 2.36, p = 0.025 and OR = 2.33, p = 0.026). In multivariable analysis, patients with ejection fraction ≤45% had higher odds of increased PLMAI during ASV than those with ejection fraction >45% (OR = 1.98, p = 0.022). In conclusion, PLMS may increase in HF patients after suppression of CSA by ASV. Whereas the clinical significance of increased post-ASV PLMS in HF prognosis needs to be determined, these increases may contribute to worsening outcomes in HF patients with CSA treated with ASV.
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Abstract
Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are under-recognized sleep disorders in children and adolescents. Several recent epidemiological studies have shown that RLS and PLMD are common in the pediatric population, and if left untreated, may lead to cardiovascular and neurocognitive consequences. Therefore, early diagnosis and intervention may help preventing long-term consequences. The management of RLS and PLMD in children involves both non-pharmacologic and pharmacologic approaches. Although there is emerging literature supporting medical therapy in children with RLS and PLMD, the overall experiences with these medications remain limited. Most children and adolescents with RLS and PLMD have low iron storage; therefore, iron therapy should be considered as the first line of treatment in children. Currently, there is no FDA-approved medication for RLS and PLMD in children. There is increasing evidence on the effectiveness of dopaminergic medications in children but the data are quite limited. Other medications such as α2δ-1 ligands, benzodiazepine, and clonidine are frequently used, but have not been adequately investigated in children. Further studies are needed to evaluate the safety and efficacy of pharmacologic therapy for RLS and PLMD in children.
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Huang Z, Goparaju B, Chen H, Bianchi MT. Heart rate phenotypes and clinical correlates in a large cohort of adults without sleep apnea. Nat Sci Sleep 2018; 10:111-125. [PMID: 29719424 PMCID: PMC5914741 DOI: 10.2147/nss.s155733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Normal sleep is associated with typical physiological changes in both the central and autonomic nervous systems. In particular, nocturnal blood pressure dipping has emerged as a strong marker of normal sleep physiology, whereas the absence of dipping or reverse dipping has been associated with cardiovascular risk. However, nocturnal blood pressure is not measured commonly in clinical practice. Heart rate (HR) dipping in sleep may be a similar important marker and is measured routinely in at-home and in-laboratory sleep testing. METHODS We performed a retrospective cross-sectional analysis of diagnostic polysomnography in a clinically heterogeneous cohort of n=1047 adults without sleep apnea. RESULTS We found that almost half of the cohort showed an increased HR in stable nonrapid eye movement sleep (NREM) compared to wake, while only 13.5% showed a reduced NREM HR of at least 10% relative to wake. The strongest correlates of HR dipping were younger age and male sex, whereas the periodic limb movement index (PLMI), sleep quality, and Epworth Sleepiness Scale (ESS) scores were not correlated with HR dipping. PLMI was however significantly correlated with metrics of impaired HR variability (HRV): increased low-frequency power and reduced high-frequency power. HRV metrics were unrelated to sleep quality or the ESS value. Following the work of Vgontzas et al, we also analyzed the sub-cohort with insomnia symptoms and short objective sleep duration. Interestingly, the sleep-wake stage-specific HR values depended upon insomnia symptoms more than sleep duration. CONCLUSION While our work demonstrates heterogeneity in cardiac metrics (HR and HRV), the population analysis suggests that pathological signatures of HR (nondipping and elevation) are common even in this cohort selected for the absence of sleep apnea. Future prospective work in clinical populations will further inform risk stratification and set the stage for testing interventions.
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Affiliation(s)
- Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Balaji Goparaju
- Department of Neurology, Division of Sleep Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - He Chen
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, People's Republic of China
| | - Matt T Bianchi
- Department of Neurology, Division of Sleep Medicine, Massachusetts General Hospital, Boston, MA, USA
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Periodic limb movements of sleep are associated with an increased prevalence of atrial fibrillation in patients with mild sleep-disordered breathing. Int J Cardiol 2017; 241:200-204. [DOI: 10.1016/j.ijcard.2017.04.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 11/22/2022]
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MEIS1 variant as a determinant of autonomic imbalance in Restless Legs Syndrome. Sci Rep 2017; 7:46620. [PMID: 28425489 PMCID: PMC5397858 DOI: 10.1038/srep46620] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/21/2017] [Indexed: 12/14/2022] Open
Abstract
Restless Legs Syndrome (RLS) is a genetically complex neurological disorder in which overlapping genetic risk factors may contribute to the diversity and heterogeneity of the symptoms. The main goal of the study was to investigate, through analysis of heart rate variability (HRV), whether in RLS patients the MEIS1 polymorphism at risk influences the sympathovagal regulation in different sleep stages. Sixty-four RLS patients with periodic leg movement index above 15 per hour, and 38 controls underwent one night of video-polysomnographic recording. HRV in the frequency- and time- domains was analyzed during nighttime sleep. All RLS patients were genotyped, and homozygotes for rs2300478 in the MEIS1 locus were used for further analysis. Comparison of the sympathovagal pattern of RLS patients to control subjects did not show significant differences after adjustments for confounding factors in frequency-domain analyses, but showed an increased variability during N2 and N3 stages in time-domain analyses in RLS patients. Sorting of RLS patients according to MEIS1 polymorphism reconfirmed the association between MEIS1 and PLMS, and showed a significant increased sympathovagal balance during N3 stage in those homozygotes for the risk allele. RLS patients should be considered differently depending on MEIS1 genotype, some being potentially at risk for cardiovascular disorders.
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Influence of sympathetic activity in the control of peripheral microvascular tone in preterm infants. Pediatr Res 2016; 80:793-799. [PMID: 27497044 DOI: 10.1038/pr.2016.160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 06/21/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Microvascular dysregulation following preterm birth is associated with increased illness severity and hypotension, particularly in males. Sympathetic nervous vascular regulation is evident in females. We hypothesized that sympathetic dysfunction in male preterm infants may contribute to a failure of peripheral microvascular vasoconstriction. METHODS Microvascular blood flow of infants 24-43 wk gestational age was assessed at 6, 24, and 72 h of age by laser Doppler. Blood flow Fourier transformed frequency distribution spectra (low frequency/high frequency ratio) were used to assess the influence of sympathetic tone on microvascular regulation. Total sympathetic output was assessed as urinary normetanephrine. RESULTS Microvascular sympathetic activity at 24 h postnatal age decreased in early preterm males, but not females. Peripheral sympathetic activity increased with advancing postnatal age in females, but decreased in males. In early preterm infants, total normetanephrine outputs increase significantly with postnatal age, in both sexes. CONCLUSION Sympathetic activation following preterm birth is sexually dimorphic, with preterm males having reduced sympathetic tone and reduced upregulation of sympathetic tone following birth. There is evidence of a disconnect between central sympathetic activity and local peripheral microcirculatory sympathetic drive. This may relate to autonomic nervous immaturity and highlights the need to understand how preterm birth may affect autonomic function.
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Longitudinal relationships of periodic limb movements during sleep and incident atrial fibrillation. Sleep Med 2016; 25:78-86. [PMID: 27823721 DOI: 10.1016/j.sleep.2016.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/17/2016] [Accepted: 08/27/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to examine relationship between periodic limb movements during sleep (PLMS) and incident atrial fibrillation/flutter (AF). METHODS Prospective multicenter cohort (n = 2273: adjudicated AF group; n = 843: self-reported AF group) of community-dwelling men without prevalent AF were followed for an average of 8.3 years (adjudicated) and 6.5 years (self-reported). PLMS index (PLMI, <5 (ref), ≥5 to <30, ≥30) and PLM arousal index (PLMAI, <1 (ref), ≥1 to <5, ≥5) were measured by polysomnography. Incident adjudicated and self-reported AF were analyzed by Cox proportional hazards and logistic regression, respectively, and adjusted for age, clinic, race, body mass index (BMI), alcohol use, cholesterol level, cardiac medications, pacemaker, apnea-hypopnea index, renal function, and cardiac risk. The interaction of age and PLMS was examined. RESULTS In this primarily Caucasian (89.8%) cohort of older men (mean age 76.1 ± 5.5 years) with BMI of 27.2 ± 3.7, there were 261 cases (11.5%) of adjudicated and 85 cases (10.1%) of self-reported incident AF. In the overall cohort, PLMI and PLMAI were not associated with adjudicated or self-reported AF. There was some evidence of an interaction of age and PLMI (p = 0.08, adjudicated AF) and PLMAI (p ≤ 0.06, both outcomes). Among men aged ≥76 years, the highest PLMI tertile was at increased risk of adjudicated AF (≥30 vs. <5; hazard ratio (HR) = 1.63, 1.01-2.63) and the middle PLMAI tertile predicted increased risk of both outcomes (1 to <5 vs. <1; adjudicated, HR = 1.65, 1.05-2.58; self-reported HR = 5.76, 1.76-18.84). No such associations were found in men aged <76 years. CONCLUSIONS Although PLMS do not predict AF incidence in the overall cohort, the findings suggest PLMS increases incident AF risk in the older subgroup.
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Miano S, Esposito M, Foderaro G, Ramelli GP, Pezzoli V, Manconi M. Sleep-Related Disorders in Children with Attention-Deficit Hyperactivity Disorder: Preliminary Results of a Full Sleep Assessment Study. CNS Neurosci Ther 2016; 22:906-914. [PMID: 27255788 DOI: 10.1111/cns.12573] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/10/2016] [Accepted: 05/05/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND METHODS We present the preliminary results of a prospective case-control sleep study in children with a diagnosis of attention-deficit hyperactivity disorder (ADHD). A deep sleep assessment including sleep questionnaires, sleep habits, a video-polysomnographic recording with full high-density electroencephalography (EEG) and cardiorespiratory polygraphy, multiple sleep latency test, and 1-week actigraphic recording were performed to verify whether children with ADHD may be classified into one of the following five phenotypes: (1) hypoarousal state, resembling narcolepsy, which may be considered a "primary" form of ADHD; (2) delayed sleep onset insomnia; (3) sleep-disordered breathing; (4) restless legs syndrome and/or periodic limb movements; and (5) sleep epilepsy and/or EEG interictal epileptiform discharges. RESULTS Fifteen consecutive outpatients with ADHD were recruited (two female, mean age 10.6 ± 2.2, age range 8-13.7 years) over 6 months. The narcolepsy-like sleep phenotype was observed in three children, the sleep onset insomnia phenotype was observed in one child, mild obstructive sleep apnea was observed in three children, sleep hyperkinesia and/or PLMs were observed in five children, while IEDs and or nocturnal epilepsy were observed in three children. Depending on the sleep phenotype, children received melatonin, iron supplementation, antiepileptic drugs, or stimulants. CONCLUSIONS Our study further highlights the need to design an efficient sleep diagnostic algorithm for children with ADHD, thereby more accurately identifying cases in which a full sleep assessment is indicated.
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Affiliation(s)
- Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.
| | - Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Giuseppe Foderaro
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Gian Paolo Ramelli
- Department of Pediatrics, San Giovanni Hospital, Bellinzona, Switzerland
| | - Valdo Pezzoli
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
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Hartzell K, Avis K, Lozano D, Feig D. Obstructive sleep apnea and periodic limb movement disorder in a population of children with hypertension and/or nocturnal nondipping blood pressures. ACTA ACUST UNITED AC 2015; 10:101-7. [PMID: 26725017 DOI: 10.1016/j.jash.2015.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 11/30/2022]
Abstract
There is a reported association between hypertension (HTN) and sleep disorders. The American Academy of Pediatrics recommends screening children with HTN for sleep disorders because sleep disorders increase the risk for cardiovascular disease. We quantified the frequency and severity of sleep disorders within our institution's hypertensive pediatric population and evaluated the effectiveness of performing nocturnal polysomnography (NPSG). In the hypertensive pediatric population referred for NPSG at our institution, 64% were diagnosed with obstructive sleep apnea (OSA) and/or periodic limb movement disorder. Thirty-three percent of those children with HTN had moderate to severe OSA, whereas only 20% of all children evaluated by NPSG had moderate to severe OSA. Those children with HTN were also two times more likely to be diagnosed with periodic limb movement disorder. Screening for sleep disorders and obtaining NPSG in children with HTN increase the identification of comorbid sleep disorders and reduce the risk for cardiovascular disease.
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Affiliation(s)
- Kimberly Hartzell
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kristin Avis
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Lozano
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel Feig
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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Simakajornboon N, Dye TJ, Walters AS. Restless Legs Syndrome/Willis-Ekbom Disease and Growing Pains in Children and Adolescents. Sleep Med Clin 2015; 10:311-22, xiv. [PMID: 26329441 DOI: 10.1016/j.jsmc.2015.05.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Recent studies have shown that restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are common in pediatric population. The diagnostic criteria for Pediatric RLS have recently been updated to simplify and integrate with newly revised adult RLS criteria. Management of RLS and PLMD involves pharmacologic and nonpharmacologic interventions. Children with low iron storage are likely to benefit from iron therapy. Although, there is limited information on pharmacologic therapy, there are emerging literatures showing the effectiveness of dopaminergic medications in the management of RLS and PLMD in children. This article covers clinical evaluation of RLS and PLMD in children and the relationship with growing pains.
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Affiliation(s)
| | - Thomas J Dye
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Arthur S Walters
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
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Wu MN, Lai CL, Liu CK, Yen CW, Liou LM, Hsieh CF, Tsai MJ, Chen SCJ, Hsu CY. Basal sympathetic predominance in periodic limb movements in sleep with obstructive sleep apnea. J Sleep Res 2015; 24:722-9. [PMID: 26118626 DOI: 10.1111/jsr.12314] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/10/2015] [Indexed: 12/01/2022]
Abstract
Because the impact of periodic limb movements in sleep (PLMS) is controversial, no consensus has been reached on the therapeutic strategy for PLMS in obstructive sleep apnea (OSA). To verify the hypothesis that PLMS is related to a negative impact on the cardiovascular system in OSA patients, this study investigated the basal autonomic regulation by heart rate variability (HRV) analysis. Sixty patients with mild-to-moderate OSA who underwent polysomnography (PSG) and completed sleep questionnaires were analysed retrospectively and divided into the PLMS group (n = 30) and the non-PLMS group (n = 30). Epochs without any sleep events or continuous effects were evaluated using HRV analysis. No significant difference was observed in the demographic data, PSG parameters or sleep questionnaires between the PLMS and non-PLMS groups, except for age. Patients in the PLMS group had significantly lower normalized high frequency (n-HF), high frequency (HF), square root of the mean of the sum of the squares of difference between adjacent NN intervals (RMSSD) and standard deviation of all normal to normal intervals index (SDNN-I), but had a higher normalized low frequency (n-LF) and LF/HF ratio. There was no significant difference in the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the Short-Form 36 and the Hospital Anxiety and Depression Scale between the two groups. After adjustment for confounding variables, PLMS remained an independent predictor of n-LF (β = 0.0901, P = 0.0081), LF/HF ratio (β = 0.5351, P = 0.0361), RMSSD (β = -20.1620, P = 0.0455) and n-HF (β = -0.0886, P = 0.0134). In conclusion, PLMS is related independently to basal sympathetic predominance and has a potentially negative impact on the cardiovascular system of OSA patients.
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Affiliation(s)
- Meng-Ni Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chiou-Lian Lai
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Kuan Liu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Wen Yen
- Department of Mechanical and Electro-mechanical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Li-Min Liou
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Hsieh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Ju Tsai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Sharon C-J Chen
- Department of Medical Imaging and Radiation Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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18
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Bruni O, Ferri R. The Emergence of Pediatric Sleep Medicine. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Jarrin DC, McGrath JJ, Poirier P, Quality Cohort Collaborative Group. Autonomic dysfunction: a possible pathophysiological pathway underlying the association between sleep and obesity in children at-risk for obesity. J Youth Adolesc 2014; 44:285-97. [PMID: 25480401 DOI: 10.1007/s10964-014-0235-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/24/2014] [Indexed: 12/12/2022]
Abstract
While mounting evidence suggests that sleep plays an important role in the etiology of obesity, the underlying pathogenic pathways are complex and unresolved. Experimental sleep deprivation studies demonstrate sympathovagal imbalance, indicative of diminished parasympathetic activity and/or heightened sympathetic activity, is consequent to poor sleep. Further, obese children exhibit sympathovagal imbalance, particularly during the night, compared to non-obese children. The question remains whether sympathovagal imbalance is one potential pathophysiological pathway underlying the association between sleep and obesity. The aim of the present study was to examine whether sympathovagal imbalance contributed to the association between sleep and obesity in children. Participants included 564 children aged 10 to 12 years (M = 11.67, SD = 0.95; 43.5% girls) from the QUALITY Cohort, a longitudinal study of children at-risk for the development of obesity. While children were at-risk due to confirmed parental obesity status, 57.7% of children were of normal body mass index (5-85th percentile). Sleep duration, sleep timing, and sleep disturbances were based on child- and parent-report. Anthropometrics were measured for central adiposity (waist circumference) and body composition (body mass index, fat mass index). Sympathovagal imbalance was derived from heart rate variability spectral analyses. Estimated path coefficients revealed that sympathovagal imbalance partially contributed to the association between poor sleep (later bedtimes, sleep-disordered breathing) and obesity. These findings highlight the importance of better understanding sympathovagal imbalance and its role in the etiology and maintenance of obesity. Future research should consider investigating nocturnal sympathovagal balance in youth.
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Affiliation(s)
- Denise C Jarrin
- École de psychologie, Centre de recherche Université Laval Robert-Giffard, Université Laval, Quebec, QC, Canada
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20
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Marcus CL, Traylor J, Gallagher PR, Brooks LJ, Huang J, Koren D, Katz L, Mason TBA, Tapia IE. Prevalence of periodic limb movements during sleep in normal children. Sleep 2014; 37:1349-52. [PMID: 25083015 DOI: 10.5665/sleep.3928] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Although the American Academy of Sleep Medicine (AASM) mandates that periodic limb movements during sleep (PLMS) be scored on every polysomnogram, and considers a periodic limb movement index (PLMI) > 5/h abnormal in children, there is a lack of community-derived data regarding the prevalence of PLMS in children, and no data to support this cutoff value. Therefore, the aim of this study was to determine the prevalence of PLMS in a sample of normal children. DESIGN Retrospective study. PARTICIPANTS 195 healthy, non-snoring children aged 5-17 years, recruited from the community, who underwent polysomnography for research purposes. METHODS PLMS were scored using the AASM 2007 criteria. MEASUREMENTS AND RESULTS The group age (median [IQR]) was 12.9 [10-15] years, and 58% were male. Sleep architecture was normal, and the obstructive apnea hypopnea index was 0.1 [0-0.3]/h. The median PLMI was 0/h, ranging from 0 to 35.5/h. Fifteen (7.7%) subjects had a PLMI > 5/h, and only 3 (1.5%) met the adult pathologic criterion of more than 15/h. Use of the 95th percentile PLMI cutoff of 7.2/h produced little difference in categorization between groups. Children with a PLMI > 5/h had a higher arousal index than those with a lower PLMI (11.6 [8.8-14.6] vs 8.1 [6.1-9.9]/h, respectively, P = 0.003). CONCLUSIONS This study provides normative data to the field and supports the clinical periodic limb movement index cutoff of > 5/h based on both prevalence and the correlate of increased sleep fragmentation. Periodic limb movements during sleep are infrequent in normal children recruited from the community. CITATION Marcus CL, Traylor J, Gallagher PR, Brooks LJ, Huang J, Koren D, Katz L, Mason TB, Tapia IE. Prevalence of periodic limb movements during sleep in normal children.
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Affiliation(s)
- Carole L Marcus
- Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Joel Traylor
- Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Paul R Gallagher
- Clinical and Translational Research Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Lee J Brooks
- Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jingtao Huang
- Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Dorit Koren
- Division of Endocrinology, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Lorraine Katz
- Division of Endocrinology, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Thornton B A Mason
- Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Ignacio E Tapia
- Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
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21
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Pepin JL, Borel AL, Tamisier R, Baguet JP, Levy P, Dauvilliers Y. Hypertension and sleep: overview of a tight relationship. Sleep Med Rev 2014; 18:509-19. [PMID: 24846771 DOI: 10.1016/j.smrv.2014.03.003] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 01/12/2023]
Abstract
Autonomic cardiovascular control changes across sleep stages. Thus, blood pressure (BP), heart rate and peripheral vascular resistance progressively decrease in non-rapid eye movement sleep. Any deterioration in sleep quality or quantity may be associated with an increase in nocturnal BP which could participate in the development or poor control of hypertension. In the present report, sleep problems/disorders, which impact either the quality or quantity of sleep, are reviewed for their interaction with BP regulation and their potential association with prevalent or incident hypertension. Obstructive sleep apnea syndrome, sleep duration/deprivation, insomnia, restless legs syndrome and narcolepsy are successively reviewed. Obstructive sleep apnea is clearly associated with the development of hypertension that is only slightly reduced by continuous positive airway pressure treatment. Shorter and longer sleep durations are associated with prevalent or incident hypertension but age, gender, environmental exposures and ethnic differences are clear confounders. Insomnia with objective short sleep duration, restless legs syndrome and narcolepsy may impact BP control, needing additional studies to establish their impact in the development of permanent hypertension. Addressing sleep disorders or sleep habits seems a relevant issue when considering the risk of developing hypertension or the control of pre-existent hypertension. Combined sleep problems may have potential synergistic deleterious effects.
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Affiliation(s)
- Jean-Louis Pepin
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; Grenoble University Hospital, EFCR Laboratory, Locomotion, Rehabilitation and Physiology Department, Grenoble, France.
| | - Anne-Laure Borel
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; Grenoble University Hospital, Endocrinology Department, Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; Grenoble University Hospital, EFCR Laboratory, Locomotion, Rehabilitation and Physiology Department, Grenoble, France
| | | | - Patrick Levy
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; Grenoble University Hospital, EFCR Laboratory, Locomotion, Rehabilitation and Physiology Department, Grenoble, France
| | - Yves Dauvilliers
- Sleep Unit, Department of Neurology, Hopital-Gui-de Chauliac, CHU Montpellier, National Reference Network for Narcolepsy, and INSERM U1061, Montpellier, France
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22
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Pediatric restless legs syndrome diagnostic criteria: an update by the International Restless Legs Syndrome Study Group. Sleep Med 2013; 14:1253-9. [DOI: 10.1016/j.sleep.2013.08.778] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 07/29/2013] [Accepted: 08/05/2013] [Indexed: 11/20/2022]
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23
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Sasai T, Matsuura M, Inoue Y. Change in heart rate variability precedes the occurrence of periodic leg movements during sleep: an observational study. BMC Neurol 2013; 13:139. [PMID: 24093585 PMCID: PMC3852097 DOI: 10.1186/1471-2377-13-139] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/18/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Several reports have described that individual periodic leg movements during sleep (PLMS) activities are associated with autonomic nervous system activity occurring shortly before each PLMS activity. Nevertheless, no study has investigated dynamic changes of autonomic nervous system activity before the onset of PLMS. This study detected changes in heart rate variability (HRV) at the onset of the period with PLMS using complex demodulation method. METHODS This study enrolled 14 patients diagnosed as having idiopathic PLMS disorder (PLMD). In periods with and without PLMS during sleep stage 2, HRV-related variables and the spectral power of fluctuation of a high frequency (HF) band (FHFB) were analyzed and compared. The changes of those parameters during transition from the period without PLMS to that with PLMS were explored. RESULTS Spectral power in the low frequency (LF) band and very low frequency (VLF) band were higher in the period with PLMS. Additionally, the average frequency in FHFB was higher. The frequency in this band fluctuated during the period with PLMS with remarkable elevation of FHFB. Moreover, spectral powers in FHFB, LF, and VLF were remarkably elevated shortly before the beginning of the period with PLMS (FHFB, -65 s; LF, -53 s; and VLF, -45 s). CONCLUSIONS Elevation of sympathetic nervous system activity and mean frequency fluctuation in an HF band can occur several tens of seconds before the period with PLMS. Dynamic changes in the autonomic nervous system activity might be related to the vulnerability to PLMS occurrence during the night.
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Affiliation(s)
- Taeko Sasai
- Department of Somnology, Tokyo Medical University, 1-24-6, Yoyogi, Shibuya-ku Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Life Sciences and Bio-informatics, Division of Biomedical Laboratory Sciences, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masato Matsuura
- Department of Life Sciences and Bio-informatics, Division of Biomedical Laboratory Sciences, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, 1-24-6, Yoyogi, Shibuya-ku Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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24
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Walter LM, Yiallourou SR, Vlahandonis A, Sands SA, Johnson CA, Nixon GM, Davey MJ, Trinder J, Walker AM, Horne RSC. Impaired blood pressure control in children with obstructive sleep apnea. Sleep Med 2013; 14:858-66. [PMID: 23768837 DOI: 10.1016/j.sleep.2013.01.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/22/2013] [Accepted: 01/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) in adults has been associated with hypertension, low baroreflex sensitivity (BRS), a delayed heart rate response to changing blood pressure (heart period delay [HPD]), and increased blood pressure variability (BPV). Poor BRS may contribute to hypertension by impairing the control of blood pressure (BP), with increased BPV and HPD. Although children with OSA have elevated BP, there are scant data on BRS, BPV, or HPD in this group. METHODS 105 children ages 7-12 years referred for assessment of OSA and 36 nonsnoring controls were studied. Overnight polysomnography (PSG) was performed with continuous BP monitoring. Subjects were assigned to groups according to their obstructive apnea-hypopnea index (OAHI): primary snoring (PS) (OAHI ≤1event/h), mild OSA (OAHI>1- ≤5events/h) and moderate/severe (MS) OSA (OAHI>5events/h). BRS and HPD were calculated using cross spectral analysis and BPV using power spectral analysis. RESULTS Subjects with OSA had significantly lower BRS (p<.05 for both) and a longer HPD (PS and MS OSA, p<.01; mild OSA, p<.05) response to spontaneous BP changes compared with controls. In all frequencies of BPV, the MS group had higher power compared with the control and PS groups (low frequency [LF], p<.05; high frequency [HF], p<.001). CONCLUSIONS Our study demonstrates reduced BRS, longer HPD, and increased BPV in subjects with OSA compared to controls. This finding suggests that children with OSA have altered baroreflex function. Longitudinal studies are required to ascertain if this dampening of the normal baroreflex response can be reversed with treatment.
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Affiliation(s)
- Lisa M Walter
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia.
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25
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Jarrin DC, McGrath JJ, Drake CL. Beyond sleep duration: distinct sleep dimensions are associated with obesity in children and adolescents. Int J Obes (Lond) 2013; 37:552-8. [PMID: 23419602 PMCID: PMC4956466 DOI: 10.1038/ijo.2013.4] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Short sleep duration is recognized as a significant risk factor in childhood obesity; however, the question as to how sleep contributes to the development of obesity remains largely unknown. The majority of pediatric studies have relied on sleep duration as the exclusive measure of sleep; this insular approach may be misleading given that sleep is a dynamic multidimensional construct beyond sleep duration, including sleep disturbances and patterns. Although these sleep dimensions partly overlap, it is necessary to determine their independent relation with obesity, which in turn, may inform a more comprehensive understanding of putative pathophysiological mechanisms linking sleep and obesity. The aim of the present study was to investigate whether sleep dimensions including sleep duration, disturbances, and patterns were individually associated with obesity, independent of multiple covariates. The second objective was to examine whether sleep disturbances and patterns were independently associated with obesity, after adjusting for sleep duration. METHODS Participants included 240 healthy children and adolescents (Mage=12.60, s.d.=1.98; 45.8% females). Anthropometric measures included measured waist and hip circumference, body mass index Z-score, and percent body fat. Subjective sleep measures included sleep duration, sleep disturbances, sleep quality, and sleep patterns from youth- and parental report. RESULTS Youth with larger adiposity and body composition measures reported poorer sleep quality (β avg=-0.14, P<0.01), more sleep disturbances (β avg=0.13, P<0.05), and showed a delayed sleep phase pattern (β avg=0.15, P<0.05), independent of age, sex, pubertal status, physical activity, screen time, socioeconomic status, and sleep duration. Shorter sleep duration was significantly associated with obesity; however, this link was attenuated after adjustment of covariates. CONCLUSIONS The results suggest that sleep measures beyond duration may more precisely capture influences that drive the negative association between sleep and obesity, and thus, yield more robust associations. As such, future studies are needed to better understand how distinct sleep dimensions confer risk for childhood obesity.
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Affiliation(s)
- D C Jarrin
- Pediatric Public Health Psychology Laboratory, Department of Psychology, Concordia University, Montréal, Quebec, Canada
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26
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Angriman M, Bruni O, Cortese S. Does Restless Legs Syndrome increase cardiovascular risk in Attention-Deficit/Hyperactivity Disorder? Med Hypotheses 2012; 80:39-42. [PMID: 23111202 DOI: 10.1016/j.mehy.2012.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 09/11/2012] [Accepted: 10/05/2012] [Indexed: 01/10/2023]
Abstract
Preliminary evidence suggests a possible association between Attention-Deficit/Hyperactivity Disorder and Restless Legs Syndrome with or without Periodic Limb Movements during Sleep. When comorbid, Restless Legs Syndrome/Periodic Limb Movements during Sleep might aggravate Attention-Deficit/Hyperactivity Disorder symptoms. Pharmacological treatment of Attention-Deficit/Hyperactivity Disorder may be associated, at least in some cases, with adverse cardiovascular events, including clinically significant elevation in heart rate and systemic blood pressure. However, the characteristics of patients with Attention-Deficit/Hyperactivity Disorder at risk for cardiovascular events during pharmacological treatment are poorly understood. Here, we hypothesize that Restless Legs Syndrome and/or Periodic Limb Movements during Sleep comorbid with Attention-Deficit/Hyperactivity Disorder increase cardiovascular risk via imbalance in activity of the autonomic nervous system. Such an imbalance of the could be related to alterations of sleep microarchitecture also detected by cyclic alternating pattern analysis. If empirical studies confirm our hypothesis, the clinician would be advised to systematically screen for and effectively treat Restless Legs Syndrome/Periodic Limb Movements during Sleep even before starting treatment with Attention-Deficit/Hyperactivity Disorder drugs. The management of Restless Legs Syndrome/Periodic Limb Movements during Sleep might reduce cardiovascular risk during pharmacological treatment of Attention-Deficit/Hyperactivity Disorder.
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Affiliation(s)
- Marco Angriman
- Child Neurology and Neurorehabilitation Unit, Department of Pediatrics, Central Hospital of Bolzano, Italy.
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27
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Gozal D, Hakim F, Kheirandish-Gozal L. Chemoreceptors, baroreceptors, and autonomic deregulation in children with obstructive sleep apnea. Respir Physiol Neurobiol 2012; 185:177-85. [PMID: 22954503 DOI: 10.1016/j.resp.2012.08.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 08/21/2012] [Accepted: 08/23/2012] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is highly prevalent sleep disorder of breathing in both adults and children that is fraught with substantial cardiovascular morbidities, the latter being attributable to a complex interplay between intermittent hypoxia (IH), episodic hypercapnia, recurrent large intra-thoracic pressure swings, and sleep disruption. Alterations in autonomic nervous system function could underlie the perturbations in cardiovascular, neurocognitive, immune, endocrine and metabolic functions that affect many of the patients suffering from OSA. Although these issues have received substantial attention in adults, the same has thus far failed to occur in children, creating a quasi misperception that children are protected. Here, we provide a critical overview of the evidence supporting the presence of autonomic nervous system (ANS) perturbations in children with OSA, draw some parallel assessments to known mechanisms in rodents and adult humans, particularly, peripheral and central chemoreceptor and baroreceptor pathways, and suggest future research directions.
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Affiliation(s)
- David Gozal
- Department of Pediatrics, Comer Children's Hospital, The University of Chicago, Chicago, IL, USA.
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28
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Miano S, Parisi P, Villa MP. The sleep phenotypes of attention deficit hyperactivity disorder: the role of arousal during sleep and implications for treatment. Med Hypotheses 2012; 79:147-53. [PMID: 22608760 DOI: 10.1016/j.mehy.2012.04.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 03/22/2012] [Accepted: 04/16/2012] [Indexed: 01/01/2023]
Abstract
About 25-50% of children and adolescents with attention-deficit hyperactivity disorder (ADHD) experience sleep problems. An appropriate assessment and treatment of such problems might improve the quality of life in such patients and reduce both the severity of ADHD and the impairment it causes. According to data in the literature and to the overall complexity of the interaction between ADHD and sleep, five sleep phenotypes may be identified in ADHD: (i) a sleep phenotype characterized mainly by a hypo-arousal state, resembling narcolepsy, which may be considered a "primary" form of ADHD (i.e. without the interference of other sleep disorders); (ii) a phenotype associated with delayed sleep onset latency and with a higher risk of bipolar disorder; (iii) a phenotype associated with sleep disordered breathing (SDB); (iv) another phenotype related to restless legs syndrome (RLS) and/or periodic limb movements; (v) lastly, a phenotype related to epilepsy/or EEG interictal discharges. Each sleep phenotype is characterized by peculiar sleep alterations expressed by either an increased or decreased level of arousal during sleep that have important treatment implications. Treatment with stimulants is recommended above all in the primary form of ADHD, whereas treatment of the main sleep disorders or of co-morbidities (i.e. bipolar disorders and epilepsy) is preferred in the other sleep phenotypes. All the sleep phenotypes, except the primary form of ADHD and those related to focal benign epilepsy or focal EEG discharges, are associated with an increased level of arousal during sleep. Recent studies have demonstrated that both an increase and a decrease in arousal are ascribable to executive dysfunctions controlled by prefrontal cortical regions (the main cortical areas implicated in the pathogenesis of ADHD), and that the arousal system, which may be hyperactivated or hypoactivated depending on the form of ADHD/sleep phenotype.
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Affiliation(s)
- Silvia Miano
- Neuroscience, Mental Health and Sense Organs Department, Chair of Pediatrics, Sleep Disorder Centre, La Sapienza University, II Faculty, Medicine, Rome, Italy.
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29
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Gingras JL, Gaultney JF, Picchietti DL. Pediatric periodic limb movement disorder: sleep symptom and polysomnographic correlates compared to obstructive sleep apnea. J Clin Sleep Med 2012; 7:603-9A. [PMID: 22171198 DOI: 10.5664/jcsm.1460] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVES Although periodic limb movements in sleep (PLMS) have been described in multiple pediatric publications, periodic limb movement disorder (PLMD) has not. The aims of this study were to describe the prevalence, sleep-related correlates, and polysomnographic correlates of PLMD in a large pediatric case series, and compare these to pediatric obstructive sleep apnea (OSA). METHODS All PLMD cases (defined by International Classification of Sleep Disorders, 2nd edition criteria + respiratory disturbance index [RDI] < 3) and OSA cases (defined by RDI ≥ 3 + PLMS < 5), from a single pediatric sleep practice, over a 2-year time span, were included. Chart, questionnaire, and polysomnographic data were compiled. Of 468 referred children, 66 PLMD cases were identified (14%). RESULTS The PLMD cases, mean age 8.1 years (range 1-17), were clinically characterized by frequent sleep onset and maintenance problems, difficulty awakening, restless sleep, leg pain/discomfort at night, and parasomnias. Compared to 90 OSA children, those with PLMD had a history of significantly more sleep onset and maintenance problems, leg pain/discomfort at night, parasomnias, getting out of bed at night, and family history of restless legs syndrome. Polysomnographically, PLMD cases had more awakenings, stage 1 sleep, stage shifts, and spontaneous arousals. CONCLUSIONS These data indicate that pediatric PLMD has important clinical and polysomnographic correlates. In addition, PLMD has many characteristics that are different from pediatric OSA, suggesting that PLMD is a distinct pediatric sleep disorder, of which clinicians should be aware.
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30
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Hakim F, Gozal D, Kheirandish-Gozal L. Sympathetic and catecholaminergic alterations in sleep apnea with particular emphasis on children. Front Neurol 2012; 3:7. [PMID: 22319509 PMCID: PMC3268184 DOI: 10.3389/fneur.2012.00007] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/10/2012] [Indexed: 01/04/2023] Open
Abstract
Sleep is involved in the regulation of major organ functions in the human body, and disruption of sleep potentially can elicit organ dysfunction. Obstructive sleep apnea (OSA) is the most prevalent sleep disorder of breathing in adults and children, and its manifestations reflect the interactions between intermittent hypoxia, intermittent hypercapnia, increased intra-thoracic pressure swings, and sleep fragmentation, as elicited by the episodic changes in upper airway resistance during sleep. The sympathetic nervous system is an important modulator of the cardiovascular, immune, endocrine and metabolic systems, and alterations in autonomic activity may lead to metabolic imbalance and organ dysfunction. Here we review how OSA and its constitutive components can lead to perturbation of the autonomic nervous system in general, and to altered regulation of catecholamines, both of which then playing an important role in some of the mechanisms underlying OSA-induced morbidities.
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Affiliation(s)
- Fahed Hakim
- Department of Pediatrics, Comer Children's Hospital, The University of Chicago Chicago, IL, USA
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31
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Rogers VE, Marcus CL, Jawad AF, Smith-Whitley K, Ohene-Frempong K, Bowdre C, Allen J, Arens R, Mason TBA. Periodic limb movements and disrupted sleep in children with sickle cell disease. Sleep 2011; 34:899-908. [PMID: 21731140 DOI: 10.5665/sleep.1124] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES To describe the rate, distribution and correlates of periodic limb movements in sleep (PLMS) in children with sickle cell disease (SCD). DESIGN Prospective, cross-sectional. SETTING Hospital-based sleep laboratory. PARTICIPANTS Sixty-four children aged 2-18 years with SCD, hemoglobin SS-type who had an overnight polysomnogram and a parent-completed Pediatric Sleep Questionnaire. Mean age was 8.4 years (SD 4.8); 50% were male. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS The mean PLMS index was 3.7 (6.6) and ranged from 0 to 31.8, with 23.4% of the sample having PLMS ≥ 5/h. Sleep efficiency was decreased (P = 0.03), and the total arousal index (P = 0.003) and PLMS arousal index (P < 0.001) were increased in children with PLMS ≥ 5/h compared to those with PLMS < 5/h. PLMS were most frequent in NREM stage 2 sleep and during the fourth hour of sleep. Inter-movement interval duration peaked at 25-30 s. "Growing pains worst in bed" or "restlessness of the legs", suggesting restless legs syndrome (RLS), were reported in 12.5% of the total sample and were more common in children with elevated PLMS. A PLMS score for identifying elevated PLMS in children, based on items from the Pediatric Sleep Questionnaire, did not significantly predict PLMS ≥ 5/h. CONCLUSIONS Elevated PLMS are common in children with SCD and are associated with sleep disruption and symptoms of RLS. Future research into the time structure of PLMS, their causes and consequences, and development of a disease-specific sleep disorders screening questionnaire, is needed in children with SCD.
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32
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Stein PK, Pu Y. Heart rate variability, sleep and sleep disorders. Sleep Med Rev 2011; 16:47-66. [PMID: 21658979 DOI: 10.1016/j.smrv.2011.02.005] [Citation(s) in RCA: 272] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/24/2011] [Accepted: 02/25/2011] [Indexed: 11/15/2022]
Abstract
Heart rate (HR) is modulated by the combined effects of the sympathetic and parasympathetic nervous systems. Therefore, measurement of changes in HR over time (heart rate variability or HRV) provides information about autonomic functioning. HRV has been used to identify high risk people, understand the autonomic components of different disorders and to evaluate the effect of different interventions, etc. Since the signal required to measure HRV is already being collected on the electrocardiogram (ECG) channel of the polysomnogram (PSG), collecting data for research on HRV and sleep is straightforward, but applications have been limited. As reviewed here, HRV has been applied to understand autonomic changes during different sleep stages. It has also been applied to understand the effect of sleep-disordered breathing, periodic limb movements and insomnia both during sleep and during the daytime. HRV has been successfully used to screen people for possible referral to a Sleep Lab. It has also been used to monitor the effects of continuous positive airway pressure (CPAP). A novel HRV measure, cardiopulmonary coupling (CPC) has been proposed for sleep quality. Evidence also suggests that HRV collected during a PSG can be used in risk stratification models, at least for older adults. Caveats for accurate interpretation of HRV are also presented.
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Affiliation(s)
- Phyllis K Stein
- Washington University, School of Medicine HRV Laboratory, 4625 Lindell Boulevard, Suite 402, Saint Louis, MO 63108, USA.
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Current World Literature. Curr Opin Pulm Med 2010; 16:623-7. [DOI: 10.1097/mcp.0b013e32834006f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Advances in pediatric restless legs syndrome: Iron, genetics, diagnosis and treatment. Sleep Med 2010; 11:643-51. [DOI: 10.1016/j.sleep.2009.11.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 11/12/2009] [Accepted: 11/18/2009] [Indexed: 11/22/2022]
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Wing YK, Zhang J, Ho CKW, Au CT, Li AM. Periodic limb movement during sleep is associated with nocturnal hypertension in children. Sleep 2010; 33:759-65. [PMID: 20550016 PMCID: PMC2881712 DOI: 10.1093/sleep/33.6.759] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that blood pressure (BP) is significantly influenced by sleep problems in children, but the association between periodic limb movement during sleep (PLMS) and BP is still unclear. This study aims to compare ambulatory blood pressure (ABP) in children with and without PLMS. METHODS AND RESULTS A cross-sectional study involving 314 children (mean (SD) age of 10.4 (1.7) years, boys 62.4%). Participants underwent an overnight polysomnographic study and ABP monitoring. Subjects were hypertensive if mean SBP or DBP > 95th percentile and prehypertensive if mean SBP or DBP > 90th percentile of reference. Children with PLMS (n = 17) were at significantly higher risk for nocturnal systolic (adjusted OR (95%CI) = 6.25 [1.87-20.88]) and diastolic (OR (95%CI) = 4.83 [1.66-14.07]) hypertension. However, mean nocturnal BP did not differ between children with and without PLMS. There was a trend for higher daytime BP in patients with PLMS than those children without PLMS (P = 0.084 for systolic BP z score; P = 0.051 for diastolic BP z score; P = 0.067 for systolic prehypertension). There were significant associations between log transformed PLM index and daytime systolic and mean BP z scores (P = 0.03 and 0.033 respectively) as well as that between log transformed PLM related arousal index (PLMSArI) and nocturnal diastolic and mean BP (P = 0.008 and 0.038 respectively). CONCLUSIONS PLMS was independently associated with a wide range of BP elevations, especially nocturnal indices. Future studies should examine the underlying pathophysiologic mechanisms and effects of PLMS treatment on BP.
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Affiliation(s)
- Yun Kwok Wing
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin Hospital, Shatin, Hong Kong SAR, China.
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