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DelRosso LM, Picchietti DL, Sharon D, Spruyt K, Owens JA, Walters AS, Zucconi M, Ferri R. Periodic limb movement disorder in children: A systematic review. Sleep Med Rev 2024; 76:101935. [PMID: 38652932 DOI: 10.1016/j.smrv.2024.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/09/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
This systematic review evaluates the scientific literature on pediatric periodic limb movement disorder (PLMD), adhering to PRISMA guidelines and utilizing PICOS criteria. The search across PubMed, EMBASE, and Scopus yielded 331 articles, with 17 meeting inclusion criteria. Diagnostic criteria evolved, with polysomnography and PLMS index ≥5 required since 2003. Also, PLMD diagnosis mandates clinical consequences like insomnia, hypersomnia, and fatigue, excluding comorbidities causing sleep disruption. Prevalence in children is low (0.3%), emphasizing the need for meticulous investigation. Comorbidities, particularly the bidirectional relationship with ADHD, were explored. Challenges in diagnosis and understanding arise from overlapping conditions such as sleep disordered breathing, psychotropic medication, and criteria non-adherence. Despite generally good study quality, weaknesses include sample size justification and biases. The periodic leg movement index shows high sensitivity but low specificity, underscoring strict diagnostic criteria adherence. Diverse metrics for symptoms necessitate standardized approaches. Family history of RLS in children with PLMD suggests unexplored aspects. Treatment, mainly iron supplementation, lacks standardized assessment metrics. The review emphasizes diagnostic and treatment challenges, recommending unbiased studies with precise techniques. Comprehensive research, quantifying PLMS and objectively assessing sleep parameters, is crucial for advancing understanding in pediatric PLMD. PROSPERO REGISTRATION NUMBER: CRD42021251406.
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Affiliation(s)
| | - Daniel L Picchietti
- University of Illinois School of Medicine, Carle Illinois College of Medicine, and Carle Health, Urbana, IL, USA.
| | - Denise Sharon
- Pomona Valley Hospital and Medical Center, Claremont, CA, USA.
| | - Karen Spruyt
- Université de Paris, NeuroDiderot, INSERM, Paris, 75019, France.
| | - Judith A Owens
- Division of Neurology, Boston Children's Hospital, Harvard Medical School, Waltham, MA, USA.
| | - Arthur S Walters
- Division of Sleep Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Marco Zucconi
- Sleep Disorders Center, Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Institute and Ospedale San Raffaele, Milan, Italy.
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy.
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2
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Leitner C, D'Este G, Verga L, Rahayel S, Mombelli S, Sforza M, Casoni F, Zucconi M, Ferini-Strambi L, Galbiati A. Neuropsychological Changes in Isolated REM Sleep Behavior Disorder: A Systematic Review and Meta-analysis of Cross-sectional and Longitudinal Studies. Neuropsychol Rev 2024; 34:41-66. [PMID: 36588140 DOI: 10.1007/s11065-022-09572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023]
Abstract
The aim of this meta-analysis is twofold: (a) to assess cognitive impairments in isolated rapid eye movement (REM) sleep behavior disorder (iRBD) patients compared to healthy controls (HC); (b) to quantitatively estimate the risk of developing a neurodegenerative disease in iRBD patients according to baseline cognitive assessment. To address the first aim, cross-sectional studies including polysomnography-confirmed iRBD patients, HC, and reporting neuropsychological testing were included. To address the second aim, longitudinal studies including polysomnography-confirmed iRBD patients, reporting baseline neuropsychological testing for converted and still isolated patients separately were included. The literature search was conducted based on PRISMA guidelines and the protocol was registered at PROSPERO (CRD42021253427). Cross-sectional and longitudinal studies were searched from PubMed, Web of Science, Scopus, and Embase databases. Publication bias and statistical heterogeneity were assessed respectively by funnel plot asymmetry and using I2. Finally, a random-effect model was performed to pool the included studies. 75 cross-sectional (2,398 HC and 2,460 iRBD patients) and 11 longitudinal (495 iRBD patients) studies were selected. Cross-sectional studies showed that iRBD patients performed significantly worse in cognitive screening scores (random-effects (RE) model = -0.69), memory (RE model = -0.64), and executive function (RE model = -0.50) domains compared to HC. The survival analyses conducted for longitudinal studies revealed that lower executive function and language performance, as well as the presence of mild cognitive impairment (MCI), at baseline were associated with an increased risk of conversion at follow-up. Our study underlines the importance of a comprehensive neuropsychological assessment in the context of iRBD.
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Affiliation(s)
- Caterina Leitner
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Giada D'Este
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Laura Verga
- Comparative Bioacoustics Group, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Faculty of Psychology and Neuroscience, Department NP&PP, Maastricht University, Maastricht, The Netherlands
| | - Shady Rahayel
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal - Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Samantha Mombelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Marco Sforza
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Francesca Casoni
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Marco Zucconi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Luigi Ferini-Strambi
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Andrea Galbiati
- "Vita-Salute" San Raffaele University, Milan, Italy.
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy.
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3
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Sforza M, Salibba A, Carollo G, Scarpellino A, Bertone JM, Zucconi M, Casoni F, Castronovo V, Galbiati A, Ferini-Strambi L. Boosting obstructive sleep apnea therapy by non-pharmacological approaches: A network meta-analysis. Sleep Med 2024; 115:235-245. [PMID: 38382310 DOI: 10.1016/j.sleep.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is the most common breathing-related sleep disorder with a considerable economic burden, low diagnosis and treatment rates. Continuous positive airway pressure (CPAP/PAP) is the principal therapy for OSA treatment; nevertheless, effectiveness is often limited by suboptimal adherence. The present network meta-analysis aims to systematically summarize and quantify different interventions' effects on CPAP/PAP adherence (such as mean usage CPAP or PAP in hours per night) in OSA patients, comparing Behavioral, Educational, Supportive and Mixed interventions in Randomized Control Trials (RCT). METHODS We conducted a computer-based search using the electronic databases of Pubmed, Psycinfo, Scopus, Embase, Chinal and Medline until August 2022, selecting 50 RCT. RESULTS By means of a random effect model network meta-analysis, results suggested that the most effective treatment in improving CPAP/PAP adherence was the Supportive approach followed by Behavioral Therapy focused on OSA treatment adherence. CONCLUSION This network meta-analysis might encourage the most experienced clinicians and researchers in the field to collaborate and implement treatments for improving CPAP/PAP treatment adherence. Moreover, these results support the importance of multidisciplinary approaches for OSA treatment, which should be framed within a biopsychological model.
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Affiliation(s)
- Marco Sforza
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.
| | - Andrea Salibba
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Giacomo Carollo
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Alessandro Scarpellino
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - John Matteo Bertone
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Francesca Casoni
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Vincenza Castronovo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Andrea Galbiati
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Luigi Ferini-Strambi
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
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4
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Berra F, Fasiello E, Zucconi M, Casoni F, De Gennaro L, Ferini-Strambi L, Galbiati A. Neurophysiological Parameters Influencing Sleep-Wake Discrepancy in Insomnia Disorder: A Preliminary Analysis on Alpha Rhythm during Sleep Onset. Brain Sci 2024; 14:97. [PMID: 38275517 PMCID: PMC10813212 DOI: 10.3390/brainsci14010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Sleep state misperception (SSM) is a common issue in insomnia disorder (ID), causing a discrepancy between objective and subjective sleep/wake time estimation and increased daytime impairments. In this context, the hyperarousal theory assumes that sustained central nervous system activation contributes to the SSM. This study investigates factors influencing SSM during sleep latency (SL) and total sleep time (TST). Objective polysomnographic sleep variables (the alpha density index, latency-to-sleep stages and the first K-complex, and Rapid Eye Movement (REM) arousal density) and subjective sleep indices, taken from sleep diaries, were analyzed in 16 ID patients. Correlation analyses revealed a positive association between the degree of SL misperception (SLm) and the percentage of epochs that contained a visually scored stereotyped alpha rhythm during objective SL. A regression analysis showed that the REM arousal density and alpha density index significantly predicted TST misperception (TSTm). Furthermore, the degree of SLm was associated with an increased probability of transitioning from stage 1 of non-REM sleep to wakefulness during subjective SL. These findings support the role of hyperarousal in SSM and highlight the importance of alpha activity in unravelling the heterogeneous underpinnings of SSM.
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Affiliation(s)
- Francesca Berra
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Elisabetta Fasiello
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Francesca Casoni
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy;
- Body and Action Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Luigi Ferini-Strambi
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Andrea Galbiati
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
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5
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Cannizzaro M, Pieri V, Curti DG, Gueye M, Rugarli G, Napoli G, Cardamone R, Falini A, Perani D, Zucconi M, Casoni F, Giaccone G, Moda F, Di Fede G, Magnani G, Caso F, Filippi M. Correction to: Sporadic Fatal Insomnia presenting with agrypnia excitata and rapidly progressive dementia: a case report. J Neurol 2023:10.1007/s00415-023-11675-5. [PMID: 36976330 DOI: 10.1007/s00415-023-11675-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Miryam Cannizzaro
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina Pieri
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Gusmeo Curti
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mor Gueye
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Rugarli
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Napoli
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrea Falini
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroradiology Unit and CERMAC, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy
- Nuclear Medicine Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Zucconi
- Sleep Disorders Centre, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Casoni
- Sleep Disorders Centre, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Giaccone
- Unit of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fabio Moda
- Unit of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Di Fede
- Unit of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Magnani
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Caso
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Mombelli S, Leitner C, D'Este G, Sforza M, Marelli S, Castelnuovo A, Zucconi M, Casoni F, Fantini ML, Novellino F, Salsone M, Ferini-Strambi L, Galbiati A. A data-driven approach to neuropsychological features in isolated REM behaviour disorder: A latent class analysis. J Neuropsychol 2023; 17:161-179. [PMID: 36192363 DOI: 10.1111/jnp.12292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
Recent evidence demonstrated that neuropsychological assessment may be considered a valid marker of neurodegeneration in idiopathic REM sleep behaviour disorder (iRBD). However, little is known about the possible neuropsychological heterogeneity within the iRBD population. This retrospective study aimed to identify and describe different neuropsychological phenotypes in iRBD patients by means of a data-driven approach using latent class analysis. A total of 289 iRBD patients underwent a neuropsychological assessment evaluating cognitive domains: global cognition, language, short- and long-term memory, executive functions and visuospatial abilities. The presence of mild cognitive impairment (MCI) was also assessed. Latent class analysis was carried out to identify iRBD subtypes according to neuropsychological scores. The most parsimonious model identified three latent classes. Groups were labelled as follows: Class 2 "severely impaired" (n = 83/289): mean pathological scores in different tests, a high percentage of MCI multiple-domain and impairment in all neuropsychological domains. Class 1 "moderately impaired" (n = 44/289): mean neuropsychological score within the normal value, a high percentage of MCI (high risk to phenoconversion) and great impairment in the visuospatial domain. Class 3 "slightly impaired" (n = 162/289): no deficit worthy of attention except for short- and long-term memory. Our results suggest three different clinical phenotypes within the iRBD population. These findings may be relevant in the future for predicting the clinical trajectories of phenoconversion in iRBD.
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Affiliation(s)
- Samantha Mombelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Leitner
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Giada D'Este
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Marco Sforza
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Sara Marelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Castelnuovo
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Zucconi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Casoni
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Livia Fantini
- Sleep and EEG, Neurophysiology Unit, Clermont-Ferrand University Hospital and UMR 6602 - Université Clermont Auvergne, CNRS, Institut Pascal, Clermont-Ferrand, France
| | - Fabiana Novellino
- Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council, Catanzaro, Italy.,Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigación Neuroquímica (IUINQ-UCM), Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
| | - Maria Salsone
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy.,Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council, Catanzaro, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Andrea Galbiati
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
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7
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Mogavero MP, DelRosso LM, Bruni O, Salemi M, Salsone M, Novellino F, Zucconi M, Ferini Strambi L, Ferri R. Genetics and epigenetics of rare hypersomnia. Trends Genet 2023; 39:415-429. [PMID: 36842900 DOI: 10.1016/j.tig.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/28/2023]
Abstract
Herein we focus on connections between genetics and some central disorders of hypersomnolence - narcolepsy types 1 and 2 (NT1, NT2), idiopathic hypersomnia (IH), and Kleine-Levin syndrome (KLS) - for a better understanding of their etiopathogenetic mechanisms and a better diagnostic and therapeutic definition. Gene pleiotropism influences neurological and sleep disorders such as hypersomnia; therefore, genetics allows us to uncover common pathways to different pathologies, with potential new therapeutic perspectives. An important body of evidence has accumulated on NT1 and IH, allowing a better understanding of etiopathogenesis, disease biomarkers, and possible new therapeutic approaches. Further studies are needed in the field of epigenetics, which has a potential role in the modulation of biological specific hypersomnia pathways.
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Affiliation(s)
- Maria Paola Mogavero
- Vita-Salute San Raffaele University, Milan, Italy; Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Lourdes M DelRosso
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Oliviero Bruni
- Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Maria Salsone
- Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular Bioimaging and Physiology, National Research Council, Milan, Italy
| | - Fabiana Novellino
- Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Marco Zucconi
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini Strambi
- Vita-Salute San Raffaele University, Milan, Italy; Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
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8
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Castelnovo A, Miano S, Ferri R, Raggi A, Maestri M, Bottasini V, Anelli M, Zucconi M, Castronovo V, Ferini-Strambi L, Manconi M. Electrophysiological and Neuropsychological Indices of Cognitive Dysfunction in Patients with Chronic Insomnia and Severe Benzodiazepine Use Disorder. Brain Sci 2023; 13:brainsci13030375. [PMID: 36979185 PMCID: PMC10046290 DOI: 10.3390/brainsci13030375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Benzodiazepine (BDZ) misuse is a growing health problem, with 1–2% of patients under BDZ treatment meeting the criteria for use disorder or dependence. Although BDZ addiction potential has been known for decades, much remains unknown its effects on brain functions. The aim of this study was to assess the neuropsychological and neurophysiological profile of a group of chronic insomniacs taking long-term high doses of benzodiazepine. We recruited 17 consecutive patients admitted to our third-level Sleep Medicine Unit for drug discontinuation (7 males, mean age 49.2 ± 11.2 years, mean education 13.7 ± 3.9 years, mean daily diazepam-equivalent BDZ: 238.1±84.5 mg) and 17 gender/age-matched healthy controls (7 males, mean age 46.8 ± 14.1 years, mean education 13.5 ± 4.5 years). We performed a full neuropsychological evaluation of all subjects and recorded their scalp event-related potentials (Mismatch-Passive Oddball-Paradigm and Active Oddball P300 Paradigm). Patients with chronic insomnia and BDZ use disorder showed a profound frontal lobe executive dysfunction with significant impairment in the cognitive flexibility domain, in face of a preserved working, short and long-term memory. In patients, P300 amplitude tended to be smaller, mainly over the frontal regions, compared to controls. BDZ use disorder has a severe cognitive impact on chronic insomnia patients. Long-term high-dose BDZ intake should be carefully evaluated and managed by clinicians in this specific patient population, especially in relation to risky activities.
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Affiliation(s)
- Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Civic Hospital of Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Civic Hospital of Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute—IRCCS, 94018 Troina, Italy
| | - Alberto Raggi
- Unit of Neurology, G.B. Morgagni–L. Pierantoni Hospital, 47121 Forlì, Italy
| | - Michelangelo Maestri
- Department of Neurosciences, Neurological Clinic, University of Pisa, 56124 Pisa, Italy
| | - Valentina Bottasini
- Sleep Disorders Center, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Matteo Anelli
- Sleep Disorders Center, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Marco Zucconi
- Sleep Disorders Center, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Vincenza Castronovo
- Sleep Disorders Center, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | | | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Civic Hospital of Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
- Correspondence: ; Tel.: +41-91-811-68-25
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9
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Liguori C, Mombelli S, Fernandes M, Zucconi M, Plazzi G, Ferini-Strambi L, Logroscino G, Mercuri NB, Filardi M. The evolving role of quantitative actigraphy in clinical sleep medicine. Sleep Med Rev 2023; 68:101762. [PMID: 36773596 DOI: 10.1016/j.smrv.2023.101762] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
Actigraphy has a consolidated role in Insomnia and Circadian Rhythm Sleep-Wake Disorders (CRSWD) and recent studies have highlighted the use of actigraphy for narcolepsy and REM sleep behaviour disorder (RBD). This review aims at summarising the results of studies published over the last decade regarding the use of actigraphy. Thirty-five studies proved eligible, and results were analysed separately for insomnia, narcolepsy and RBD. Actigraphy showed to consistently differentiate insomnia patients from healthy controls. Furthermore, the application of advanced analytical techniques has been shown to provide both unique insights into the physiology of insomnia and sleep misperception and to improve the specificity of actigraphy in detecting wakefulness within sleep periods. Regarding narcolepsy, several studies showed that actigraphy can detect peculiar sleep/wake disruption and the effects of pharmacological treatments. Finally, although the number of studies in RBD patients is still limited, the available evidence indicates a reduced amplitude of the activity pattern, sleep-wake rhythm dysregulation and daytime sleepiness. Therefore, the potential use of these markers as predictors of phenoconversion should be further explored. In conclusion, quantitative actigraphy presents a renewed interest when considering the possibility of using actigraphy in clinical sleep medicine to diagnose, monitor, and follow sleep disorders other than CRSWD.
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Affiliation(s)
- Claudio Liguori
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.
| | - Samantha Mombelli
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Milan, Italy
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy; Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy; Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Italy
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10
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D’Este G, Berra F, Carli G, Leitner C, Marelli S, Zucconi M, Casoni F, Ferini-Strambi L, Galbiati A. Cognitive Reserve in Isolated Rapid Eye-Movement Sleep Behavior Disorder. Brain Sci 2023; 13:brainsci13020176. [PMID: 36831719 PMCID: PMC9954116 DOI: 10.3390/brainsci13020176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
Isolated rapid-eye-movement sleep behaviour disorder (RBD) is considered the prodromal stage of α-synucleinopathies (e.g., Parkinson's disease and dementia with Lewy bodies); however, iRBD patients show a wide variety in the progression timing (5-15 years). The model of cognitive reserve (CR) might contribute to explaining this phenomenon. Our exploratory study aimed to evaluate, for the first time, the impact of CR level on cognitive performance in polysomnography-confirmed iRBD patients. Fifty-five iRBD patients (mean age ± SD: 66.38 ± 7.51; M/F 44/11) underwent clinical and neuropsychological evaluations at the time of diagnosis. The CR Index questionnaire was part of the clinical assessment. We found that iRBD patients with high levels of CR showed: (i) the lowest percentage of mild cognitive impairment (10%), and (ii) the best performance in visuo-constructive and verbal memory functions (i.e., the recall of the Rey-Osterrieth complex figure test). Our results suggest that CR might help iRBD patients better cope with the cognitive decline related to the neurodegenerative process, providing the first preliminary findings supporting CR as a possible protective factor in this condition. This might pave the way for future longitudinal studies to evaluate the role of CR as a modulating factor in the timing of iRBD conversion and cognitive deterioration development.
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Affiliation(s)
- Giada D’Este
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy
- Sleep Disorders Center, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Francesca Berra
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy
- Sleep Disorders Center, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giulia Carli
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Caterina Leitner
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy
- Sleep Disorders Center, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Sara Marelli
- Sleep Disorders Center, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Marco Zucconi
- Sleep Disorders Center, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Francesca Casoni
- Sleep Disorders Center, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Luigi Ferini-Strambi
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy
- Sleep Disorders Center, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Andrea Galbiati
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy
- Sleep Disorders Center, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Correspondence: ; Tel.: +39-022-643-3397
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11
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Gorgoni M, Pietrogiacomi F, Reda F, Galbiati A, Fasiello E, Camaioni M, Scarpelli S, Alfonsi V, Casoni F, Zucconi M, Ferini-Strambi L, De Gennaro L. Alterations of the human K-complexes during NREM sleep in isolated REM sleep behaviour disorder. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Sforza M, Nese M, Carollo G, D'Este G, Casoni F, Zucconi M, Levendowski D, Strambi LF, Galbiati A. Sleep reactivity to anticipatory anxiety: preliminary results from a home-EEG sleep monitoring and virtual reality study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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13
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Sforza M, Sala M, Leitner C, Casoni F, Zucconi M, Galbiati A, Ferini Strambi L, Castronovo V. Affective states in predicting and mediating Cognitive-Behavioral Therapy for Insomnia. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Zhang H, Iranzo A, Högl B, Arnulf I, Ferini‐Strambi L, Manni R, Miyamoto T, Oertel WH, Dauvilliers Y, Ju Y, Puligheddu M, Sonka K, Pelletier A, Montplaisir JY, Stefani A, Ibrahim A, Frauscher B, Leu‐Semenescu S, Zucconi M, Terzaghi M, Miyamoto M, Janzen A, Figorilli M, Fantini ML, Postuma RB. Risk factors for phenoconversion in
REM
sleep behavior disorder. Ann Neurol 2022; 91:404-416. [DOI: 10.1002/ana.26298] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 12/14/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Hui Zhang
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
- Department of Neurology McGill University, Montreal General Hospital Montreal Canada
| | - Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona IDIBAPS, CIBERNED Barcelona Spain
| | - Birgit Högl
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Isabelle Arnulf
- Sorbonne University, Paris Brain Institute and sleep disorder unit Pitie‐Salpetriere Hospital, APHP Paris France
| | | | | | - Tomoyuki Miyamoto
- Department of Neurology, Dokkyo Medical University Saitama Medical Center Saitama Japan
| | | | - Yves Dauvilliers
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, INSERM U1061 Montpellier F‐34093 Cedex 5 France
| | - Yo‐EI Ju
- Washington University School of Medicine, Department of Neurology St. Louis Missouri USA
| | - Monica Puligheddu
- Sleep Center, Department of Cardiovascular and Neurological Sciences University of Cagliari Italy
| | - Karel Sonka
- Department of Neurology First Faculty of Medicine, Charles University and General University Hospital Prague Czech Republic
| | - Amélie Pelletier
- Centre d'Études Avancées en Médecine du Sommeil Hôpital du Sacré‐Cœur de Montréal Montréal Canada
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil Hôpital du Sacré‐Cœur de Montréal Montréal Canada
- Department of Psychiatry University of Montreal Montreal Canada
| | - Ambra Stefani
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Abubaker Ibrahim
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Birgit Frauscher
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Smaranda Leu‐Semenescu
- Sorbonne University, Paris Brain Institute and sleep disorder unit Pitie‐Salpetriere Hospital, APHP Paris France
| | - Marco Zucconi
- Sleep Disorders Center Università Vita‐Salute San Raffaele Milan Italy
| | | | - Masayuki Miyamoto
- Department of Neurology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Annette Janzen
- Department of Neurology Philipps‐Universität Marburg Germany
| | - Michela Figorilli
- Sleep Center, Department of Cardiovascular and Neurological Sciences University of Cagliari Italy
| | - Maria L Fantini
- Sleep Center, Department of Cardiovascular and Neurological Sciences University of Cagliari Italy
- Department of Neurology Université d'Auvergne Clermont‐Ferrand France
| | - Ronald B Postuma
- Department of Neurology McGill University, Montreal General Hospital Montreal Canada
- Centre d'Études Avancées en Médecine du Sommeil Hôpital du Sacré‐Cœur de Montréal Montréal Canada
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15
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Galbiati A, Carli G, Fasiello E, Casoni F, Zucconi M, De Gennaro L, Perani D, Ferini-Strambi L. Exploring the functional role and neural correlates of K-complexes in isolated rapid eye movement sleep behavior disorder. Cortex 2021; 145:105-114. [PMID: 34710676 DOI: 10.1016/j.cortex.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023]
Abstract
Underlying neural mechanisms and cognitive implications of non-Rapid Eye Movement (NREM) sleep in isolated Rapid Eye Movement (REM) sleep behavior disorder (iRBD) are not yet fully elucidated. This study aims to evaluate brain metabolic connectivity of the anterior default mode network (ADMN) underlying a waveform that is an hallmark of NREM sleep, namely K-complex (KC) and their implication for neuropsychological functioning in iRBD patients. Combining polysomnographic and multivariate molecular imaging (FDG-PET) approaches may provide crucial insights regarding KCs role in the prodromal stages of synucleinopathies. We applied a seed-based interregional correlation analysis on FDG-PET data. iRBD patients with cognitive decline displayed a reduced KC density (KCd) in comparison to patients without cognitive impairments. KCd showed a significant positive correlation with global cognitive functioning, specifically with visuo-spatial and executive performances, two cognitive domains known to be relevant in predicting conversion into neurodegenerative disorders. Increased KCd was associated with a more preserved ADMN connectivity. Our study underlines the importance of NREM sleep in prodromal stages of synucleinopathies, and future investigations might clarify its role in iRBD.
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Affiliation(s)
- Andrea Galbiati
- "Vita-Salute" San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.
| | - Giulia Carli
- "Vita-Salute" San Raffaele University, Milan, Italy; In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Fasiello
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesca Casoni
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Daniela Perani
- "Vita-Salute" San Raffaele University, Milan, Italy; In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Luigi Ferini-Strambi
- "Vita-Salute" San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
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16
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Mombelli S, Leitner C, Sforza M, Galbiati A, D'Este G, Marelli S, Zucconi M, Casoni F, Ferini-Strambi L. A data driven approach to neuropsychological features in isolated rem behavior disorder: A follow-up investigation. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Penzel T, Pevernagie D, Bassetti C, Peigneux P, Paunio T, McNicholas WT, Dogas Z, Grote L, Rodenbeck A, Cirignotta F, d'Ortho MP, Nobili L, Paiva T, Pollmächer T, Riemann D, Zucconi M, Hill EA, Arnardottir ES, Parrino L. Sleep medicine catalogue of knowledge and skills - Revision. J Sleep Res 2021; 30:e13394. [PMID: 34041812 DOI: 10.1111/jsr.13394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
The 'catalogue of knowledge and skills' for sleep medicine presents the blueprint for a curriculum, a textbook, and an examination on sleep medicine. The first catalogue of knowledge and skills was presented by the European Sleep Research Society in 2014. It was developed following a formal Delphi procedure. A revised version was needed in order to incorporate changes that have occurred in the meantime in the International Classification of Sleep Disorders, updates in the manual for scoring sleep and associated events, and, most important, new knowledge in sleep physiology and pathophysiology. In addition, another major change can be observed in sleep medicine: a paradigm shift in sleep medicine has taken place. Sleep medicine is no longer a small interdisciplinary field in medicine. Sleep medicine has increased in terms of recognition and importance in medical care. Consequently, major medical fields (e.g. pneumology, cardiology, neurology, psychiatry, otorhinolaryngology, paediatrics) recognise that sleep disorders become a necessity for education and for diagnostic assessment in their discipline. This paradigm change is considered in the catalogue of knowledge and skills revision by the addition of new chapters.
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Affiliation(s)
- Thomas Penzel
- Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Philippe Peigneux
- Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Tiina Paunio
- Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Zoran Dogas
- Sleep Medicine Center, Department of Neuroscience, School of Medicine, University of Slit, Split, Croatia
| | - Ludger Grote
- Sleep Dsorders Center, Salgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Marie-Pia d'Ortho
- Centre du Sommeil, Service de Physiologie - Explorationes Fonctionelles, Hopital Bichat Claude Bernard, APHP and Université Paris 7, Paris, France
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS G. Gaslini Institute, Genoa, Italy.,Department of Neuroscience - Rehabilitation - Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genova, Italy
| | | | | | - Dieter Riemann
- Sleep Medicine Center, Department of Psychaitry, University Freiburg, Freiburg, Germany
| | - Marco Zucconi
- Department of Clinical Neurosciences, San Raffaele Hospital, Milan, Italy
| | - Elizabeth A Hill
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
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18
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Castelnovo A, Ferri R, Galbiati A, Rossi A, Zucconi M, Castronovo V, Strambi LF, Manconi M. Extreme sleep state misperception: From psychopathology to objective-subjective sleep measures. Int J Psychophysiol 2021; 167:77-85. [PMID: 34216692 DOI: 10.1016/j.ijpsycho.2021.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVES We tested the hypothesis that patients with extreme sleep state misperception display higher levels of psychopathology and reduced quantitative estimation abilities compared to other patients with insomnia. Secondary aims included the evaluation of group differences in subjective self-reported quality of life and sleep quality and objective sleep parameters. METHODS In this cross-sectional, observational study, 249 patients with insomnia underwent a video-polysomnography with a subsequent morning interview to assess self-reported sleep estimates and filled in a large battery of questionnaires. Patients were classified into High Misperception (HM) and Moderate Misperception (MM) groups, according to the complement of the ratio between self-reported total sleep time and objective total sleep time (Misperception Index). RESULTS No significant differences emerged in any of the psychopathological measures considered between the HM and the MM group. Similarly, no effect was observed in quantitative estimation abilities. HM patients displayed a significantly increased number of awakenings per hour of sleep and a reduced dream recall rate. Their overall sleep quality and quality of life was significantly impaired. CONCLUSIONS Future research on sleep misperception should focus on factors other than the level of psychopathology and estimation abilities, in particular sleep microstructure and quantitative EEG studies in both REM and NREM sleep.
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Affiliation(s)
- Anna Castelnovo
- Sleep Medicine, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | | | - Andrea Galbiati
- Division of Neuroscience, Sleep Disorders Center-Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Marco Zucconi
- Division of Neuroscience, Sleep Disorders Center-Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenza Castronovo
- Division of Neuroscience, Sleep Disorders Center-Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi-Ferini Strambi
- Division of Neuroscience, Sleep Disorders Center-Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mauro Manconi
- Sleep Medicine, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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19
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Mombelli S, Castelnuovo A, Marelli S, Gialdi G, Somma A, Zucconi M, Fossati A, Ferini-Strambi L. 514 Narcocataplectic patients, psychiatric symptoms and executive functions: is there a link? Sleep 2021. [DOI: 10.1093/sleep/zsab072.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Narcolepsy with cataplexy (NC) is a neurological disorder characterized by orexin deficiency in the hypothalamus with associations to areas implied in emotion. Several studies highlighted a deficit in executive functions in narcoleptic patients. Moreover literature reports a wide comorbidity between NC and psychiatric disorders, but the relationships in NC patients are still unclear. The aim of our study is to evaluate possible mood and anxiety disorders in NC patients and understand their relationship with cognitive performances.
Methods
We assessed 15 NC patients with questionnaires concerning degree of somnolence [ESS], depression [BDI-II], perceived stress [PSS], state and trait anxiety [STAY-Y I and II]. Furthermore, patients performed a battery test (PEBL - psychology experiment building language) to investigate executive functions through 7 tests (Berg’s Card Sorting Test [BCST]; Tower of London [TOL]; Continuous Performance Task [CPT]; Go / No-go Task; Victoria Stroop Test [VST]; Balloon Analogue Risk Task [BART]; Digit Span Forward).
Results
Descriptive analyses show that NC subjects have pathological daytime sleepiness (16,07±2,94), moderate perceived stress (19,73±3,95), mild state anxiety (48,67±15,77). However, subjects do not show pathological indexes in depression and in trait anxiety. We also found a positive correlation in both state and trait anxiety with failure to maintain set in the BCST test (r=0,644; p=0,010 and r=0,573; p=0,025, respectively). However, no significant correlations were found between PEBL scores and excessive daytime sleepiness, depression, and perceived stress.
Conclusion
Our data confirm that NC subjects show symptoms related to stress and anxiety, that can facilitate the change of the set during cognitive performances. Since the neurotransmission of hypocretin is involved in the regulation of stress and anxiety, it is important to understand whether these symptoms are primary pathological phenomena in NC patients. Our data suggest that sleep medicine experts should also consider psychiatric aspects during the cognitive assessment of NC patients.
Support (if any)
None
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Affiliation(s)
- Samantha Mombelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Castelnuovo
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Marelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy. Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy
| | - Giulia Gialdi
- School of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy
| | - Antonella Somma
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy
| | - Marco Zucconi
- Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Fossati
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy
| | - Luigi Ferini-Strambi
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy. Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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20
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Sforza M, Scarpellino A, Salibba A, Galbiati A, Zucconi M, Casoni F, Ferini-Strambi L, Castronovo V. 371 Insomnia and Metacognitive abilities: a new treatment target? Sleep 2021. [DOI: 10.1093/sleep/zsab072.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Metacognition is defined as the ability to reflect on one’s mental state. Literature showed that dysfunctional metacognitive activity (such as worry and rumination) plays an important role in insomnia genesis and maintenance. The aim of this study is (i) to evaluate metacognition differences between insomnia disorders (ID) patients and good sleepers (GS)and (ii) to assess Cognitive-Behavioral Therapy for Insomnia (CBT-I) effectiveness on both insomnia and metacognitive abilities.
Methods
We compared 27 GS (Insomnia Severity Index, ISI<10) (63.0% female, mean age 33±13.7yrs) and 27 ID patients (51.9% female, mean age 46.4±13.7yrs) evaluated both by ISI and Metacognition Insomnia Questionnaire (MCQ-I). ID patients underwent 7-session of group CBT-I and were evaluated pre- (T0) and post- (T1) treatment.
Results
GS and ID patients differed in MCQ-I total score (GS=105.6±20.5 vs ID= 138.1±26.2). All ID patients’ scores were above the clinical cutoff of 110. ID patients showed significant improvements both at ISI (T0=14.67±4.67 vs T1=7.07±4.37, p<0.001) and Sleep Diary parameters (T0 vs T1, p<0.05) as sleep latency, wake after sleep onset and sleep efficiency at T1. ID patients also showed an improvement of MCQ-I scores at T1, nevertheless, maintaining MCQ-I the mean score above the clinical cutoff level (MCQ-I_T0=138.1±26.2 vs MCQ-I_T1=123.7±28.6; p<0.05). Indeed, 29.6% of ID patients maintained equal or worse MCQ-I score at T1 compared to T0; 63% of ID patients still had a MCQ-I score above the clinical cutoff at T1.
Conclusion
CBT-I results effective on insomnia symptoms. Metacognitive dysfunctions appears to be a core feature in ID patients compared to good sleepers. Although the score reduction was significant after CBT-I, metacognitive dysfunction did not show remission after treatment possibly indicating the need of a specific intervention on this aspect. Metacognitive dysfunction in ID needs to be further investigated and may represent a new treatment target, in order to improve CBT-I effectiveness.
Support (if any)
None
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Affiliation(s)
- Marco Sforza
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy
| | | | - Andrea Salibba
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy
| | - Andrea Galbiati
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy
| | - Marco Zucconi
- Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Casoni
- Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini-Strambi
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy. Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenza Castronovo
- Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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21
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Sforza M, Salibba A, Scarpellino A, Galbiati A, Zucconi M, Casoni F, Ferini-Strambi L, Castronovo V. 370 Depressive symptoms in the context of Cognitive-Behavioral Therapy for Insomnia, a long-term follow-up study. Sleep 2021. [DOI: 10.1093/sleep/zsab072.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cognitive-Behavioral Therapy for Insomnia (CBT-I) is considered the first-choice treatment for Insomnia Disease (ID). The bi-directional causal relationship between insomnia and depression is recognized. Aim of our study is to investigate the role of depressive symptoms in predicting CBT-I outcomes, and the effectiveness of the treatment both on insomnia and depression.
Methods
77 ID patients (mean age 38.2±10.4 years, 69.2% females) underwent 7-sessions group CBT-I and were assessed pre- (T0) post- (T1) and at long-term after CBT-I (T2=7.6±1.6 years after treatment). The primary outcomes are Insomnia Severity Index (ISI) and Sleep Diary parameters. The secondary outcome is Beck Depression Inventory-II (BDI). Patients were divided in two groups according to BDI baseline score (≥14): depressive (D) vs non-depressive (ND).
Results
All patients showed significant improvements at ISI score at T1 that were maintained at T2 (T0=16.2±4.8 vs T1=8.2±4.5 vs T2=10.0±6.1;p<0.001). Also Sleep Diary parameters (sleep latency, wake after sleep onset and sleep efficiency) showed significant improvement at T1 (p<0.001). Moreover all patients showed improvements of depressive symptoms at T1 that were maintained at T2 (T0=10.8±6.8 vs T1=6.2±5.5 vs T2=8.2±6.6; p<0.001). Indeed, if 29.3% if ID patients at T0 presented clinically significant depressive symptoms (BDI≥14), only 9.7% at T1 and 20.5% at T2. Nevertheless, we found an interaction between ISI along time (T0-T1-T2) and D vs ND group membership (ISI_TREAT*BDI_BL_GROUP Sig=p<0.05). In other words, group D patients at baseline showed a worsening of insomnia symptoms at the long-term evaluation (T2).
Conclusion
CBT-I showed improvements both in insomnia and in depressive symptoms at the end of treatment that are maintained at long-term (7.6yrs after treatment). Nevertheless, clinically significant depressive symptoms at the baseline predicted a worsening of insomnia at the long-term evaluation. This could suggest the need of a more frequent follow-up evaluation of CBT-I efficacy in those patients presenting depressive symptoms at the baseline.
Support (if any)
None
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Affiliation(s)
- Marco Sforza
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy
| | - Andrea Salibba
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy
| | | | - Andrea Galbiati
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy
| | - Marco Zucconi
- Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Casoni
- Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini-Strambi
- Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, Italy. Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenza Castronovo
- Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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22
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Abstract
Propriospinal myoclonus (PSM) consists of paroxysmal and sudden jerks involving axial flexion trunk and hip muscles, conditioning sudden myoclonias of the trunk and arms/limbs, both spontaneous and triggered by sensory stimulations, emerging in relaxed wakefulness typically during the transition between wake and sleep. Generally, PSM originates from a thoracic myelomere and spreads caudally and rostrally, provoking flexion and/or extension movements, leading to jumps or trunk jerks. They appear triggered by the lying-down position and disappear when the subject stands up. The main consequences are the difficulties in sleep start and the reappearance during the period of wakefulness after sleep onset.
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Affiliation(s)
- Marco Zucconi
- Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Hospital, Via Stamira d'Ancona, 20, Milan 20127, Italy.
| | - Francesca Casoni
- Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Hospital, Via Stamira d'Ancona, 20, Milan 20127, Italy
| | - Andrea Galbiati
- Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Hospital, Via Stamira d'Ancona, 20, Milan 20127, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, Neurologic Unit, Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, IRCCS San Raffaele Hospital, Università Vita-Salute San Raffaele, Milan, Italy
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23
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Galbiati A, Sforza M, Fasiello E, Casoni F, Marrella N, Leitner C, Zucconi M, Ferini-Strambi L. The association between emotional dysregulation and REM sleep features in insomnia disorder. Brain Cogn 2020; 146:105642. [PMID: 33190030 DOI: 10.1016/j.bandc.2020.105642] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022]
Abstract
Rapid Eye Movement (REM) sleep is involved in nightly emotional processing; therefore, its disruption might be associated with an impaired ability of emotional regulation during daytime. Accordingly, the aim of the present study was to evaluate the presence of emotional dysregulation in insomnia patients and to test its correlation with REM sleep features. Forty-six subjects (23 insomnia patients and 23 healthy controls) were enrolled. All subjects underwent an assessment for the evaluation of emotion dysregulation (Difficulties in Emotion Regulation Scale, DERS), sleep quality, insomnia severity, excessive daytime sleepiness, worry, rumination, depressive and anxious symptomatology. Insomnia patients underwent a nocturnal polysomnographic recording to characterize sleep macrostructure and REM sleep microstructure variables. Insomnia patients reported increased values of emotional dysregulation. REM sleep percentage and REM sleep latency significantly correlated with DERS total score, and with the subscales "Lack of Confidence in Emotional Regulation Skills", "Difficulties in Behavioral Control" and "Difficulty in recognizing emotions". Furthermore, positive correlations between REM arousal index and emotion dysregulation were found, whereas REM density negatively correlated with DERS. Our results suggest the presence of a relationship between REM sleep and emotional regulation in insomnia patients.
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Affiliation(s)
- Andrea Galbiati
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy.
| | - Marco Sforza
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy
| | - Elisabetta Fasiello
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Francesca Casoni
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Nadia Marrella
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Caterina Leitner
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy
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24
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Galbiati A, Zucconi M. Polysomnographic alterations in rem sleep behavior disorder: Where we are now? Sleep Med Rev 2020; 54:101364. [PMID: 32889415 DOI: 10.1016/j.smrv.2020.101364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Andrea Galbiati
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy; Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Zucconi
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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25
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Schenck CH, Zucconi M, Ferri R. Use of clonazepam in REM sleep behavior disorder is not associated with fall-related injuries. J Clin Sleep Med 2020; 16:1399-1400. [PMID: 32406373 DOI: 10.5664/jcsm.8566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, Minnesota
| | - Marco Zucconi
- Sleep Disorders Centre, Department of Neurology, Scientific Institute and University Hospital San Raffaele, Vita-Salute University, Milan, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
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26
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Abstract
Purpose of the review There is evidence that, before the coronavirus pandemic 2019 (COVID-19), healthcare workers did not experience good sleep quality with relevant consequences on health. By contrast, little is known about the sleep quality of medical staff during the COVID-19 pandemic. In this review, we aimed to contribute with a review of the literature, sharing our clinical experience supported by actigraphic evaluation and by proposing future strategies. Recent findings Sleep disorders, in particular insomnia, have been commonly reported in frontline medical workers, in hospitals during the COVID-19 pandemic and are often accompanied by depressive and anxiety symptoms. Sleep quality, however, has been mainly assessed by the use of self-reported measures, thus limiting clinical usefulness. Summary Poor sleep quality among the medical staff is prevalent, and our experience supports that this has increased during the COVID-19 pandemic. A longitudinal investigation assessing whether and for how long sleep remains altered in medical staff could be of interest to evaluate the temporal effect of the pandemic on health.
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Affiliation(s)
- Luigi Ferini-Strambi
- Vita-Salute San Raffaele University, Milan, Italy.,Sleep Disorders Center, Division of Neuroscience, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Zucconi
- Sleep Disorders Center, Division of Neuroscience, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesca Casoni
- Sleep Disorders Center, Division of Neuroscience, IRCCS San Raffaele Hospital, Milan, Italy
| | - Maria Salsone
- Sleep Disorders Center, Division of Neuroscience, IRCCS San Raffaele Hospital, Milan, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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27
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Sforza M, Castronovo V, Galbiati A, Zucconi M, Oldani A, Casoni F, Ferini-Strambi L. 0522 Subtypes of Insomniacs Treated by Cognitive-Behavioral Therapy. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Insomnia disorder (ID) is characterized by high degree of heterogeneity. Aim of our study was to identify ID patients subtypes in terms of sleep and non-sleep clinical baseline (BL) features and CBT-I efficacy.
Methods
294 chronic insomnia patients (61.6% female, mean age 40.7 ± 12.3 yrs) underwent 7-sessions group CBT-I. By use of latent class analysis (LCA) we identified ID subtypes according to BL score of Glasgow Sleep Effort Scale (GSES); Epworth Sleepiness Scale (ESS); Dysfunctional Beliefs and Attitudes about Sleep (DBAS -16); Morningness-Eveningness Questionnaire Self-Assessment (MEQ-SA); Perceived Stress Scale (PSS); Profile of Mood States (POMS); Beck Depression Inventory (BDI-II); Stay-Trait Anxiety Inventory (STAI-Y); Treatment effectiveness (Delta score of Insomnia Severity Index ISI between BL and end-of-treatment).
Results
We chose 3 latent classes as most parsimonious model. According to questionnaires’ cut-off, we labeled three classes: Class 1 (insomnia+anxiety+depression+stress) (n=62), Class 2 (insomnia+anxiety+depression) (n=153), Class 3 (only insomnia) (n=79). The variables that best differentiate the 3 classes were POMS (.772), STAY (.660), PSS (.545), BDI (.406) and ISI (.228) at BL. In particular, for ISI, the best item predicting groups differentiation was item 3 on the impact of insomnia on daytime functioning (.224). Moreover, we found a significant interaction between CBT-I treatment effect and the 3 classes at the ISI score (p=.001), GSES score (p=.002), DBAS score (p<.05), PSS score (p<.001), POMS score (p<.001), BDI score (p<.001) and STAI-Y score (p<.001).
Conclusion
Our data driven analysis results suggest that the heterogeneity of ID patients can be best represented by non-sleep scores, in particular those regarding depression, anxiety, stress and daytime functioning. These information can be useful in predicting the outcome of CBT-I.
Support
No
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Affiliation(s)
- M Sforza
- Sleep Disorder Center, Vita-Salute San Raffaele University, Milan, ITALY
| | - V Castronovo
- Sleep Disorder Center, San Raffaele Hospital, Milan, ITALY
| | - A Galbiati
- Sleep Disorder Center, Vita-Salute San Raffaele University, Milan, ITALY
| | - M Zucconi
- Sleep Disorder Center, San Raffaele Hospital, Milan, ITALY
| | - A Oldani
- Sleep Disorder Center, San Raffaele Hospital, Milan, ITALY
| | - F Casoni
- Sleep Disorder Center, San Raffaele Hospital, Milan, ITALY
| | - L Ferini-Strambi
- Sleep Disorder Center, Vita-Salute San Raffaele University, Milan, ITALY
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28
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Postuma RB, Iranzo A, Hu M, Högl B, Boeve BF, Manni R, Oertel WH, Arnulf I, Ferini-Strambi L, Puligheddu M, Antelmi E, Cochen De Cock V, Arnaldi D, Mollenhauer B, Videnovic A, Sonka K, Jung KY, Kunz D, Dauvilliers Y, Provini F, Lewis SJ, Buskova J, Pavlova M, Heidbreder A, Montplaisir JY, Santamaria J, Barber TR, Stefani A, St Louis EK, Terzaghi M, Janzen A, Leu-Semenescu S, Plazzi G, Nobili F, Sixel-Doering F, Dusek P, Bes F, Cortelli P, Ehgoetz Martens K, Gagnon JF, Gaig C, Zucconi M, Trenkwalder C, Gan-Or Z, Lo C, Rolinski M, Mahlknecht P, Holzknecht E, Boeve AR, Teigen LN, Toscano G, Mayer G, Morbelli S, Dawson B, Pelletier A. Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder: a multicentre study. Brain 2020; 142:744-759. [PMID: 30789229 PMCID: PMC6391615 DOI: 10.1093/brain/awz030] [Citation(s) in RCA: 535] [Impact Index Per Article: 133.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 12/27/2022] Open
Abstract
Idiopathic REM sleep behaviour disorder (iRBD) is a powerful early sign of Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy. This provides an unprecedented opportunity to directly observe prodromal neurodegenerative states, and potentially intervene with neuroprotective therapy. For future neuroprotective trials, it is essential to accurately estimate phenoconversion rate and identify potential predictors of phenoconversion. This study assessed the neurodegenerative disease risk and predictors of neurodegeneration in a large multicentre cohort of iRBD. We combined prospective follow-up data from 24 centres of the International RBD Study Group. At baseline, patients with polysomnographically-confirmed iRBD without parkinsonism or dementia underwent sleep, motor, cognitive, autonomic and special sensory testing. Patients were then prospectively followed, during which risk of dementia and parkinsonsim were assessed. The risk of dementia and parkinsonism was estimated with Kaplan-Meier analysis. Predictors of phenoconversion were assessed with Cox proportional hazards analysis, adjusting for age, sex, and centre. Sample size estimates for disease-modifying trials were calculated using a time-to-event analysis. Overall, 1280 patients were recruited. The average age was 66.3 ± 8.4 and 82.5% were male. Average follow-up was 4.6 years (range = 1-19 years). The overall conversion rate from iRBD to an overt neurodegenerative syndrome was 6.3% per year, with 73.5% converting after 12-year follow-up. The rate of phenoconversion was significantly increased with abnormal quantitative motor testing [hazard ratio (HR) = 3.16], objective motor examination (HR = 3.03), olfactory deficit (HR = 2.62), mild cognitive impairment (HR = 1.91-2.37), erectile dysfunction (HR = 2.13), motor symptoms (HR = 2.11), an abnormal DAT scan (HR = 1.98), colour vision abnormalities (HR = 1.69), constipation (HR = 1.67), REM atonia loss (HR = 1.54), and age (HR = 1.54). There was no significant predictive value of sex, daytime somnolence, insomnia, restless legs syndrome, sleep apnoea, urinary dysfunction, orthostatic symptoms, depression, anxiety, or hyperechogenicity on substantia nigra ultrasound. Among predictive markers, only cognitive variables were different at baseline between those converting to primary dementia versus parkinsonism. Sample size estimates for definitive neuroprotective trials ranged from 142 to 366 patients per arm. This large multicentre study documents the high phenoconversion rate from iRBD to an overt neurodegenerative syndrome. Our findings provide estimates of the relative predictive value of prodromal markers, which can be used to stratify patients for neuroprotective trials.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada.,Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Michele Hu
- Oxford Parkinson's Disease Centre (OPDC) and Oxford University, Oxford, UK
| | - Birgit Högl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS, C.Mondino Foundation, Pavia, Italy
| | | | - Isabelle Arnulf
- Sleep disorders unit, Pitie-Salpetriere Hospital, IHU@ICM and Sorbonne University, Paris, France
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Monica Puligheddu
- Sleep Center, Department of Cardiovascular and Neurological Sciences, University of Cagliari, Italy
| | - Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of the Neurological Sciences, Ospedale Bellaria, ASL di Bologna, Bologna, Italy
| | - Valerie Cochen De Cock
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France; EuroMov, University of Montpellier, Montpellier, France
| | - Dario Arnaldi
- Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, and Polyclinic San Martino Hospital, Genoa, Italy
| | - Brit Mollenhauer
- Department of Neurosurgery (C.T.) University Medical Center, Göttingen; Paracelsus-Elena-Klinik (B.M., C.T. F. S-D.), Kassel, Germany
| | - Aleksandar Videnovic
- Movement Disorders Unit and Division of Sleep Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Karel Sonka
- Department of Neurology and Centre of Clinical Neurosciences of the First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Ki-Young Jung
- Neuroscience Research Institute, Seoul National University College of Medicine, Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Dieter Kunz
- Institute of Physiology Charité-Universitätsmedizin Berlin. Germany
| | - Yves Dauvilliers
- Sleep Unit, Department of Neurology, Hôpital Gui de Chauliac, Montpellier, INSERM U1061, Montpellier, F-34093 Cedex 5 France
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Simon J Lewis
- Brain and Mind Centre University of Sydney, Camperdown, Australia
| | - Jitka Buskova
- National Institute of Mental Health, Klecany, Third Faculty of Medicine, Charles Unviersity, Prague, Czech Republic
| | - Milena Pavlova
- Department of Neurology, Brigham and Women's Hospital, Boston; Harvard Medical School, Boston, USA
| | - Anna Heidbreder
- Institute for Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Jacques Y Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Joan Santamaria
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France; EuroMov, University of Montpellier, Montpellier, France
| | - Thomas R Barber
- Oxford Parkinson's Disease Centre (OPDC) and Oxford University, Oxford, UK
| | - Ambra Stefani
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS, C.Mondino Foundation, Pavia, Italy
| | - Annette Janzen
- Department of Neurology, Philipps-Universität, Marburg, Germany
| | - Smandra Leu-Semenescu
- Sleep disorders unit, Pitie-Salpetriere Hospital, IHU@ICM and Sorbonne University, Paris, France
| | - Guiseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of the Neurological Sciences, Ospedale Bellaria, ASL di Bologna, Bologna, Italy
| | - Flavio Nobili
- Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, and Polyclinic San Martino Hospital, Genoa, Italy
| | - Friederike Sixel-Doering
- Department of Neurosurgery (C.T.) University Medical Center, Göttingen; Paracelsus-Elena-Klinik (B.M., C.T. F. S-D.), Kassel, Germany
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neurosciences of the First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Frederik Bes
- Institute of Physiology Charité-Universitätsmedizin Berlin. Germany
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | | | - Jean-Francois Gagnon
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Carles Gaig
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Marco Zucconi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Claudia Trenkwalder
- Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, and Polyclinic San Martino Hospital, Genoa, Italy
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Christine Lo
- Oxford Parkinson's Disease Centre (OPDC) and Oxford University, Oxford, UK
| | - Michal Rolinski
- Oxford Parkinson's Disease Centre (OPDC) and Oxford University, Oxford, UK
| | - Philip Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Evi Holzknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | | | - Gianpaolo Toscano
- Unit of Sleep Medicine and Epilepsy, IRCCS, C.Mondino Foundation, Pavia, Italy
| | - Geert Mayer
- Department of Neurology, Hephata Klinik, Schwalmstadt-Treysa, Germany
| | - Silvia Morbelli
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa and Polyclinic San Martino Hospital, Genoa, Italy
| | - Benjamin Dawson
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada
| | - Amelie Pelletier
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada.,Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
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Galbiati A, Sforza M, Poletti M, Verga L, Zucconi M, Ferini-Strambi L, Castronovo V. Insomnia Patients With Subjective Short Total Sleep Time Have a Boosted Response to Cognitive Behavioral Therapy for Insomnia Despite Residual Symptoms. Behav Sleep Med 2020; 18:58-67. [PMID: 30468399 DOI: 10.1080/15402002.2018.1545650] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Two distinct insomnia disorder (ID) phenotypes have been proposed, distinguished on the basis of an objective total sleep time less or more than 6 hr. In particular, it has been recently reported that patients with objective short sleep duration have a blunted response to cognitive behavioral therapy for insomnia (CBT-I). The aim of this study was to investigate the differences of CBT-I response in two groups of ID patients subdivided according to total sleep time. Methods: Two hundred forty-six ID patients were subdivided into two groups, depending on their reported total sleep time (TST) assessed by sleep diaries. Patients with a TST greater than 6 hr were classified as "normal sleepers" (NS), while those with a total sleep time less than 6 hr were classified as "short sleepers" (SS). Results: The delta between Insomnia Severity Index scores and sleep efficiency at the beginning as compared to the end of the treatment was significantly higher for SS in comparison to NS, even if they still exhibit more insomnia symptoms. No difference was found between groups in terms of remitters; however, more responders were observed in the SS group in comparison to the NS group. Conclusions: Our results demonstrate that ID patients with reported short total sleep time had a beneficial response to CBT-I of greater magnitude in comparison to NS. However, these patients may still experience the presence of residual insomnia symptoms after treatment.
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Affiliation(s)
- Andrea Galbiati
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Sforza
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mattia Poletti
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Verga
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Marco Zucconi
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini-Strambi
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenza Castronovo
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Sharon D, Allen R, Martinez-Martin P, Walters A, Strambi LF, Hogl B, Trotti L, Buchfuhrer M, Swieca J, Bogan R, Zak R, Hensley J, Schaefer L, Marelli S, Zucconi M, Stefani A, Holzknecht E, Olvera V, Meaklim H, Laska I, Becker P. Validation of the self-administered version of the international restless legs syndrome study group severity rating scale - the sIRLS. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Galbiati A, Carli G, Dodich A, Marelli S, Caterina P, Cerami C, Zucconi M, Ferini-Strambi L. Qualitative Scoring of the Pentagon Test: A Tool for the Identification of Subtle Cognitive Deficits in Isolated REM Sleep Behavior Disorder Patients. Arch Clin Neuropsychol 2019; 34:1113-1120. [PMID: 31259381 DOI: 10.1093/arclin/acz024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/01/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) frequently represents the prodromal stage of alpha-synucleinopathies, and similar to these pathologies, iRBD patients show neuropsychological deficits, particularly in the domain of visuospatial abilities and executive functions. We hypothesized that the qualitative scoring of the Mini-Mental State Examination pentagon test (QSPT) may detect subtle visuospatial deficits in these subjects, and we evaluated its relationship with indexes of sleep quality, as measured by polysomnography. METHODS A total of 80 polysomnography-confirmed iRBD patients and 40 healthy controls (HCs) were retrospectively recruited. Global and specific qualitative performances were evaluated according to QSPT procedure. Comparisons between iRBD and HC regarding all QSPT parameters, neuropsychological tests, and polysomnographic recordings were performed. RESULTS Patients displayed significantly lower scores in both "closing-in" and total score parameters in comparison to HC. The QSPT total score exhibited significant positive correlations with verbal comprehension, fluency, visuospatial abilities, and executive functions. Notably, iRBD patients with impaired performance at QSPT showed decreased neuropsychological performances and higher percentages of slow wave sleep (SWS). In addition, SWS percentages negatively correlated with verbal comprehension, fluency, visuospatial abilities, executive functions, and QSPT total score. CONCLUSION QSPT may represent a brief and easy to administer tool for the detection of subtle visuospatial changes in iRBD patients. Furthermore, polysomnographic findings suggest a possible slowdown of electroencephalographic pattern during non-REM sleep in iRBD patients in line with the presence of cognitive decline.
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Affiliation(s)
- Andrea Galbiati
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Giulia Carli
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy.,Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Dodich
- NIMTlab, Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, Geneva, Switzerland
| | - Sara Marelli
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pagnini Caterina
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Cerami
- Neurorehabilitation Unit and Cognitive Neuroscience Laboratory, Istituti Clinici Scientifici Maugeri IRCCS di Pavia, Pavia, Italy
| | - Marco Zucconi
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
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32
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Ferini-Strambi L, Galbiati A, Fasiello E, Montanaro M, Zucconi M. 0651 REM Sleep Without Atonia (RSWA) And Neuropsychological Function In REM Sleep Behavior Disorder. Sleep 2019. [DOI: 10.1093/sleep/zsz067.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Elisabetta Fasiello
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology – Sleep Disorders Center, Milan, Italy
| | - Massimo Montanaro
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology – Sleep Disorders Center, Milan, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology – Sleep Disorders Center, Milan, Italy
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33
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Sharon D, Allen RP, Martinez-Martin P, Walters AS, Ferini Strambi L, Högl B, Trotti LM, Buchfuhrer M, Swieca J, Bogan RK, Zak R, Hensley JG, Schaefer LA, Marelli S, Zucconi M, Stefani A, Holzknecht E, Olvera V, Meaklim H, Laska I, Becker PM. Validation of the self-administered version of the international Restless Legs Syndrome study group severity rating scale – The sIRLS. Sleep Med 2019; 54:94-100. [DOI: 10.1016/j.sleep.2018.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/06/2018] [Accepted: 10/16/2018] [Indexed: 11/25/2022]
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34
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Castelnovo A, Ferri R, Punjabi NM, Castronovo V, Garbazza C, Zucconi M, Ferini-Strambi L, Manconi M. The paradox of paradoxical insomnia: A theoretical review towards a unifying evidence-based definition. Sleep Med Rev 2018; 44:70-82. [PMID: 30731262 DOI: 10.1016/j.smrv.2018.12.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 01/23/2023]
Abstract
Paradoxical insomnia is one of the most intriguing yet challenging subtypes of insomnia. Despite being recognized for a long time by the international community, it is still unclear whether this entity really exists, which are its features and boundaries. Much of the debate is fuelled by the lack of a consensus on its precise definition. To help filling some of the existing gaps, a systematic review of the literature was conducted, through which 19 different quantitative definitions were obtained. These definitions were then applied to two distinct datasets. The first consisted of 200 chronic primary insomnia patients, diagnosed according to the DSM-IV-TR criteria. The second consisted of 200 age- and sex-matched healthy persons without insomnia. For each dataset, available data from the objective sleep parameters and their subjective estimation were imported and analysed in MATLAB. Depending on the definition used, the prevalence of paradoxical insomnia ranged from 8 to 66%, while agreement between different definitions ranged from -0.19 to 0.9 (using Cohen's kappa coefficient). Based on the results garnered, necessary features for a quantitative definition of paradoxical insomnia were identified. Several open questions remain, such as whether there is a minimum number of hours a patient should sleep to fulfill the criteria for a diagnosis of paradoxical insomnia, and whether sleep latency can be used in the definition along with total sleep time. We conclude by advocating continued study of paradoxical insomnia and sleep state misperception and by providing specific directions for future research. STATEMENT OF SIGNIFICANCE: The current understanding of paradoxical insomnia and, more broadly, of sleep state misperception, is greatly hampered by the lack of agreement on a quantitative and evidence-base measure of the discrepancy between subjective and objective sleep evaluation. The current study provides a critical analysis about the strength and the limitations of the available definitions, using both a data-driven and a theory-driven approach. The overarching goal is to motivate a rigorous discussion involving the main experts of the field, to build a consensus, and develop an evidence-based measure of sleep state misperception and/or of paradoxical insomnia.
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Affiliation(s)
- Anna Castelnovo
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland.
| | | | - Naresh M Punjabi
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vincenza Castronovo
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Corrado Garbazza
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Marco Zucconi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland; Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy.
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35
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Zucconi M, Galbiati A, Rinaldi F, Casoni F, Ferini-Strambi L. An update on the treatment of Restless Legs Syndrome/Willis-Ekbom Disease: prospects and challenges. Expert Rev Neurother 2018; 18:705-713. [PMID: 30095315 DOI: 10.1080/14737175.2018.1510773] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is a sleep disorder characterized by an urge to move the legs, frequently associated or triggered by unpleasant sensations in the lower limbs that affects approximately 2.5% of adults. Therapy and management of RLS/WED require long-term interventions, since the typical manifestation of this disorder is chronic. Areas covered: In this review, we provide an update regarding the treatment of RLS/WED with particular attention to future challenges for its management. We reviewed a large variety of treatments studied in clinical trials and supported by the most updated guidelines. Alongside with first-line interventions other pharmacological options including opioids, benzodiazepines, iron therapy, and newly studied drugs are discussed. Furthermore, due to the occurrence of augmentation and worsening of symptoms we also reviewed the development of non-pharmacologic alternatives. Expert commentary: The management of RLS/WED is a challenge because of different long-term issues. Several complications, such as loss of the therapeutic effect of dopaminergic or non-dopaminergic agents and augmentation, are still unsolved concerns. However, the development of new drugs acting on adenosinergic and glutamatergic neurotransmission seems promising. Randomized controlled trials are needed in order to recognize effectiveness of new drugs or non-pharmacological treatment strategies.
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Affiliation(s)
- Marco Zucconi
- a Department of Clinical Neurosciences, Neurology - Sleep Disorders Center , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Andrea Galbiati
- a Department of Clinical Neurosciences, Neurology - Sleep Disorders Center , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b Faculty of Psychology , "Vita-Salute" San Raffaele University , Milan , Italy
| | - Fabrizio Rinaldi
- a Department of Clinical Neurosciences, Neurology - Sleep Disorders Center , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Francesca Casoni
- a Department of Clinical Neurosciences, Neurology - Sleep Disorders Center , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Luigi Ferini-Strambi
- a Department of Clinical Neurosciences, Neurology - Sleep Disorders Center , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b Faculty of Psychology , "Vita-Salute" San Raffaele University , Milan , Italy
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36
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Castelnovo A, Sagrada C, Bottasini V, Castronovo V, Zucconi M, Ferini-Strambi L, Manconi M. 0421 Quantitative Estimation Ability and Personality Assessment in Paradoxical and Psychophysiological Insomnia. Sleep 2018. [DOI: 10.1093/sleep/zsy061.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Castelnovo
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, SWITZERL
| | - C Sagrada
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milano, ITALY
| | - V Bottasini
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milano, ITALY
| | - V Castronovo
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milano, ITALY
| | - M Zucconi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milano, ITALY
| | - L Ferini-Strambi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milano, ITALY
| | - M Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, SWITZERL
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37
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Giora E, Galbiati A, Zucconi M, Ferini-Strambi L. 0679 Impaired Visual Processing In Rbd Patients: A Visual Search Task Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Giora
- San Raffaele Scientific Institute, Sleep Disorders Center, Milan, ITALY
| | - A Galbiati
- San Raffaele Scientific Institute, Sleep Disorders Center, Milan, ITALY
| | - M Zucconi
- San Raffaele Scientific Institute, Sleep Disorders Center, Milan, ITALY
| | - L Ferini-Strambi
- San Raffaele Scientific Institute, Sleep Disorders Center, Milan, ITALY
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38
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Castronovo V, Galbiati A, Sforza M, Poletti M, Giarolli L, Kuo T, Zucconi M, Manconi M, Hensley M, Morin C, Ferini-Strambi L. Long-term clinical effect of group cognitive behavioral therapy for insomnia: a case series study. Sleep Med 2018; 47:54-59. [PMID: 29753926 DOI: 10.1016/j.sleep.2018.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/08/2018] [Accepted: 03/11/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy for insomnia (CBT-I) is recognized as the first-choice intervention for insomnia. One of the best-known advantages of CBT-I in comparison with pharmacotherapy is its long-term effect. However, only few studies have assessed its benefits with follow-up periods of longer than three years. In this clinical case series study we aimed to describe the long-term effects of group CBT-I after a mean 7.8 ± 1.6 years of follow-up (range 4-10 years). METHODS A total of 292 insomnia disorder (ID) patients were consecutively enrolled at the Sleep Disorders Center of San Raffaele Hospital, Milan; 123 patients (82 (66.7%) females and 41 (33.3%) males, mean age 40.59 ± 11.89 years) completed the follow-up evaluation within a range of 4-10 years. RESULTS In the 258 patients who completed the treatment, insomnia severity index (ISI) total score improved significantly as well as all variables of the sleep diaries. Using ISI as the primary outcome, we demonstrated that the effect of CBT-I is maintained up to 10 years after the end of treatment. Furthermore, we found that patients that used only CBT-I techniques to deal with relapses were the ones with better outcomes, in particular compared to the patients that re-used medications. CONCLUSION To the best of our knowledge this is the longest follow-up evaluation in the literature, both for group and individual CBT-I. These findings have an important clinical implication both suggesting and confirming that CBT-I can be considered the treatment of choice for insomnia.
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Affiliation(s)
- Vincenza Castronovo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Andrea Galbiati
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy
| | - Marco Sforza
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Mattia Poletti
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Laura Giarolli
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Tracy Kuo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Michael Hensley
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, 2305, Australia
| | - Charles Morin
- Université Laval, École de Psychologie, Québec City, QC, Canada
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy.
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Ferri R, DelRosso LM, Aricò D, Zucconi M, Ferini-Strambi L, Picchietti DL, Pizza F, Plazzi G, Manconi M, Bruni O. Leg movement activity during sleep in school-age children and adolescents: a detailed study in normal controls and participants with restless legs syndrome and narcolepsy type 1. Sleep 2018; 41:4818765. [DOI: 10.1093/sleep/zsy010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/23/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Lourdes M DelRosso
- University of California, San Francisco, CA
- Benioff Children’s Hospital Oakland, CA
| | | | - Marco Zucconi
- Department of Neurology, Sleep Disorders Center, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Luigi Ferini-Strambi
- Department of Neurology, Sleep Disorders Center, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Daniel L Picchietti
- University of Illinois School of Medicine and Carle Foundation Hospital, Urbana, IL
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche, ASL di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche, ASL di Bologna, Bologna, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
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40
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Ferri R, Silvani A, Rundo F, Zucconi M, Aricò D, Bruni O, Ferini-Strambi L, Manconi M. Data-driven approaches to define the upper limit of the intermovement interval of periodic leg movements during sleep. Sleep 2018; 41:4807239. [DOI: 10.1093/sleep/zsy008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/23/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | | | - Marco Zucconi
- Department of Neurology, Sleep Disorders Center, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | | | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Luigi Ferini-Strambi
- Department of Neurology, Sleep Disorders Center, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
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41
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Ferini-Strambi L, Zucconi M, Oldani A, Ferri C, Giora E, Galbiati A. Might hypnotic drug formulation impact on the potential for abuse? Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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42
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Castronovo V, Poletti M, Sforza M, Giarolli L, Galbiati A, Marelli S, Kuo T, Zucconi M, Manconi M, Ferini-Strambi L. Depressive symptoms in insomnia: long-term changes after cognitive-behavioral therapy for insomnia (CBT-I). Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sforza M, Poletti M, Galbiati A, Verga L, Zucconi M, Ferini-Strambi L, Castronovo V. Evaluation of the outcome of cognitive behavioral therapy for insomnia in patients with subjective short or normal total sleep time. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Giora E, Galbiati A, Marelli S, Zucconi M, Ferini-Strambi L. Evidence of perceptive impairment in OSA patients investigated by means of a visual search task. Cortex 2017; 95:136-142. [DOI: 10.1016/j.cortex.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/22/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
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Galbiati A, Abutalebi J, Iannaccone S, Borsa VM, Musteata S, Zucconi M, Giora E, Ferini-Strambi L. The effects of Transcranial Direct Current Stimulation (tDCS) on Idiopathic Hypersomnia: a pilot study. Arch Ital Biol 2017; 154:1-5. [PMID: 27548094 DOI: 10.12871/00039829201611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Idiopathic Hypersomnia (IH) is a rare sleep disorder characterised by excessive daytime sleepiness (EDS) that leads to invalidating daytime consequences. Till now the treatment of IH has mirrored that of sleepiness in narcolepsy, and it is mainly focused on symptoms' management. We employed an anodal transcranic Direct Current Stimulation (tDCS) treatment in order to induce a shift toward arousal in IH patients' cortex during the day. Every patients underwent a 4 weeks treatment (3 stimulations per week, for a total of 12 stimulations over a period of 28 days) with an assessment at the baseline and after treatment aimed to the evaluation of subjective daytime sleepiness, neurocognitive functions, and attentional domain tested by means of the Attentional Network Task (ANT). The dependent variables of the ANT are accuracy and reaction times, which represent the objective outcome of our study. A significant effect of tDCS' treatment in reducing EDS was found. Besides the amelioration in subjective EDS, an objective improvement in RTs in all conditions of the ANT, in particular in the more difficult component, was observed. Our results indicate that tDCS may foster the management of EDS in IH, improving also the attentional domain.
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Affiliation(s)
| | | | | | | | | | | | | | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, University San Raffaele and Scientific Institute San Raffaele, Milan, 20132 Milan, Italy;
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Morrone E, Sguazzin C, Bertolotti G, Giordano A, Braghiroli A, Balestroni GL, Manni R, Ferini Strambi L, Castronovo V, Zucconi M, De Carli F, Pinna E, Ottonello M, Giorgi I, Terzaghi M, Marelli S, Fanfulla F. Development and validation of the Maugeri Sleep Quality and Distress Inventory (MaSQuDI-17). PLoS One 2017; 12:e0180743. [PMID: 28700701 PMCID: PMC5507265 DOI: 10.1371/journal.pone.0180743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives The aim of this study was to develop and validate a questionnaire designed to measure the impact of sleep impairment on emotional distress in patients with various sleep disorders. Methods Five experts created an item data-bank pertaining to sleep-related psychological symptoms and somatic perceptions. Fifty patients in two focus groups examined each item for: a) word clarity (indicating any ambiguity of interpretation) and b) appropriateness for the target population. This process permitted to identify 36 appropriate items. Classical Test Theory and Rasch Analysis were used to further refine the questionnaire, yielding the final 17-item set. Concurrent validation of the new scale was tested with the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and the Anxiety and Depression questionnaires. Results Starting from the initial item data-bank, a 17-item questionnaire, the Maugeri Sleep Quality and Distress Inventory (MaSQuDI–17), was produced. Parallel Analysis on the MaSQuDI–17 confirmed the presence of a single dimension; exploratory factor analysis showed salient loading for each item, explaining 58.7% of total variance. Item-remainder correlation ranged from 0.72 to 0.39 and Cronbach alpha was 0.896. Rasch analysis revealed satisfactory psychometric properties of the new scale: the rating structure performed according to expectations, model fit was good and no item dependencies emerged. The scale presented good convergent validity and scores significantly distinguished healthy subjects from OSAS or Insomnia or BSD (p < 0.001). Conclusions MaSQuDI –17 shows good psychometric qualities, and can be used to assess the impact of sleep disorders such as Insomnia, OSAS, Central Hypersomnia and BSD on emotional stress.
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Affiliation(s)
- Elisa Morrone
- Sleep Medicine Unit, Istituti Clinici Scientifici Maugeri, Scientific Istitute of Pavia IRCCS, Pavia, Italy
| | - Cinzia Sguazzin
- Psychology Unit, Istituti Clinici Scientifici Maugeri, Scientific Istitute of Pavia IRCCS, Pavia Italy
| | - Giorgio Bertolotti
- Psychology Unit, ICS Maugeri, Istituti Clinici Scientifici Maugeri, Scientific Istitute of Tradate IRCCS, Tradate, Italy
| | - Andrea Giordano
- Unit of Bioengineering, Istituti Clinici Scientifici Maugeri, Scientific Istitute of Veruno IRCCS, Veruno, Italy
| | - Alberto Braghiroli
- Division of Respiratory Disease, Istituti Clinici Scientifici Maugeri, Scientific Istitute of Veruno IRCCS, Veruno, Italy
| | - Gian Luigi Balestroni
- Psychology Unit, Istituti Clinici Scientifici Maugeri, Scientific Istitute of Veruno IRCCS, Veruno, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy
| | - Luigi Ferini Strambi
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center, Università Vita-Salute San Raffaele, Milano, Italy
| | - Vincenza Castronovo
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center, Università Vita-Salute San Raffaele, Milano, Italy
| | - Marco Zucconi
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center, Università Vita-Salute San Raffaele, Milano, Italy
| | - Fabrizio De Carli
- Institute of Bioimaging and Molecular Physiology, National Research Council (CNR) Genova, Italy
| | - Eleonora Pinna
- Psychology Unit, Istituti Clinici Scientifici Maugeri, Scientific Istitute of Pavia IRCCS, Pavia Italy
| | - Marcella Ottonello
- Psychology Unit, Istituti Clinici Scientifici Maugeri, Scientific Istitute of Genova Nervi, Genova,Italy
| | - Ines Giorgi
- Psychology Unit, Istituti Clinici Scientifici Maugeri, Scientific Istitute of Pavia IRCCS, Pavia, Italy
| | - Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy
| | - Sara Marelli
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center, Università Vita-Salute San Raffaele, Milano, Italy
| | - Francesco Fanfulla
- Sleep Medicine Unit, Istituti Clinici Scientifici Maugeri, Scientific Istitute of Pavia IRCCS, Pavia, Italy
- * E-mail:
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Ferini Strambi L, Marelli S, Zucconi M, Galbiati A, Biggio G. Effects of different doses of triazolam in the middle-of-the-night insomnia: a double-blind, randomized, parallel group study. J Neurol 2017; 264:1362-1369. [PMID: 28584913 DOI: 10.1007/s00415-017-8530-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 12/22/2022]
Abstract
It has been reported that insomnia characterized by difficulty returning to sleep following a nocturnal awakening, otherwise defined as the middle-of-the-night (MOTN) insomnia, is a common form of insomnia in adults with growing prevalence by increasing age. The aim of this study is to evaluate the efficacy and safety of different dosages of triazolam in insomnia patients when taken after a MOTN awakening with difficulty returning to sleep. In this double-blind, randomized, parallel group study, 24 patients (mean age 41.00 ± 10.40, 10 female and 14 male) affected by MOTN insomnia were enrolled and randomized into three groups according to different dosages of triazolam: group A (0.0625 mg), group B (0.125 mg), and group C (0.250 mg). A significant increment of total sleep time, sleep efficiency and a reduction of wake after sleep onset, number of awakening and non-REM sleep stage 1 was observed in T1 (triazolam) in comparison to T0 (placebo) by means of polysomnographic recording, irrespective of dosage. After 2 weeks of the treatment, insomnia severity significantly improved in all three groups in comparison to baseline without diurnal residual effects. This study demonstrates that low dose of triazolam objectively and subjectively improves the sleep of patients having MOTN insomnia.
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Affiliation(s)
- Luigi Ferini Strambi
- Departments of Clinical Neurosciences, Neurology, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | - Sara Marelli
- Departments of Clinical Neurosciences, Neurology, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Zucconi
- Departments of Clinical Neurosciences, Neurology, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Galbiati
- Departments of Clinical Neurosciences, Neurology, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Biggio
- Neuroscience Institute, National Research Council, Cagliari, Italy
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Ferri R, Rundo F, Silvani A, Zucconi M, Bruni O, Ferini-Strambi L, Plazzi G, Manconi M. REM Sleep EEG Instability in REM Sleep Behavior Disorder and Clonazepam Effects. Sleep 2017; 40:3800356. [DOI: 10.1093/sleep/zsx080] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ferini-Strambi L, Giora E, Galbiati A, Marelli S, Zucconi M. 0616 A PERCEPTIVE IMPAIRMENT IN OSA PATIENTS ASSESSED BY MEANS OF A VISUAL SEARCH TASK. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Kuo T, Castronovo V, Giarolli L, Galbiati A, Sforza M, Poletti M, Marelli S, Zucconi M, Ferini Strambi L. 0361 LONG-TERM OUTCOME OF GROUP COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA (CBT-I). Sleep 2017. [DOI: 10.1093/sleepj/zsx050.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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