1
|
Leclair-Visonneau L, Feemster JC, Bibi N, Gossard TR, Jagielski JT, Strainis EP, Carvalho DZ, Timm PC, Bliwise DL, Boeve BF, Silber MH, McCarter SJ, St. Louis EK. Contemporary diagnostic visual and automated polysomnographic REM sleep without atonia thresholds in isolated REM sleep behavior disorder. J Clin Sleep Med 2024; 20:279-291. [PMID: 37823585 PMCID: PMC10835777 DOI: 10.5664/jcsm.10862] [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: 04/11/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
STUDY OBJECTIVES Accurate diagnosis of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is crucial due to its injury potential and neurological prognosis. We aimed to analyze visual and automated REM sleep without atonia (RSWA) diagnostic thresholds applicable in varying clinical presentations in a contemporary cohort of patients with iRBD using submentalis (SM) and individual bilateral flexor digitorum superficialis (FDS) and anterior tibialis electromyography limb recordings during polysomnography. METHODS We analyzed RSWA in 20 patients with iRBD and 20 age-, REM-, apnea-hypopnea index-matched controls between 2017 and 2022 for phasic burst durations, density of phasic, tonic, and "any" muscle activity (number of 3-second mini-epochs containing phasic or tonic muscle activity divided by the total number of REM sleep 3-second mini-epochs), and automated Ferri REM atonia index (RAI). Group RSWA metrics were comparatively analyzed. Receiver operating characteristic curves determined optimized area under the curve (AUC) and maximized specificity and sensitivity diagnostic iRBD RSWA thresholds. RESULTS All mean RSWA metrics were higher in patients with iRBD than in controls (P < .05), except for selected anterior tibialis measures. Optimized, maximal specificity AUC diagnostic cutoffs for coprimary outcomes were: SM "any" 6.5%, 14.0% (AUC = 92.5%) and combined SM+FDS "any" 15.1%, 27.4% (AUC = 95.8%), while SM burst durations were 0.72, and 0.72 seconds (AUC 90.2%) and FDS RAI = 0.930, 0.888 (AUC 92.8%). CONCLUSIONS This study provides evidence for current quantitative RSWA diagnostic thresholds in chin and individual 4 limb muscles applicable in different iRBD clinical settings and confirms the key value of SM or SM+FDS to assure accurate iRBD diagnosis. Evolving iRBD recognition underscores the necessity of continuous assessment with future large, prospective, well-harmonized, multicenter polysomnographic analyses. CITATION Leclair-Visonneau L, Feemster JC, Bibi N, et al. Contemporary diagnostic visual and automated polysomnographic REM sleep without atonia thresholds in isolated REM sleep behavior disorder. J Clin Sleep Med. 2024;20(2):279-291.
Collapse
Affiliation(s)
- Laurène Leclair-Visonneau
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Clinical Neurophysiology, CHU de Nantes, Nantes, France
- Nantes Université, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
| | - John C. Feemster
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Noor Bibi
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Thomas R. Gossard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Jack T. Jagielski
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Emma P. Strainis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Diego Z. Carvalho
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Paul C. Timm
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Donald L. Bliwise
- Emory Sleep Center and Department of Neurology, Emory University, Atlanta, Georgia
| | - Bradley F. Boeve
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Michael H. Silber
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Stuart J. McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Erik K. St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Clinical and Translational Science, Mayo Clinic Health System Southwest Wisconsin, La Crosse, Wisconsin
| |
Collapse
|
2
|
Silber MH. Who discovered REM sleep? Sleep 2024; 47:zsad232. [PMID: 37665949 PMCID: PMC10782487 DOI: 10.1093/sleep/zsad232] [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: 08/27/2023] [Indexed: 09/06/2023] Open
Affiliation(s)
- Michael H Silber
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| |
Collapse
|
3
|
Pagani-Estévez GL, Holland MT, Tippmann-Peikert M, Benarroch EE, Silber MH, Carvalho DZ. Potential therapeutic benefit of spinal cord stimulation in restless legs syndrome: scoping review and mechanistic considerations. Pain Med 2023; 24:S18-S23. [PMID: 37833049 DOI: 10.1093/pm/pnad089] [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] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/22/2023] [Accepted: 06/26/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Restless legs syndrome (RLS) is a prevalent sensorimotor disorder that can dramatically impair sleep quality, daytime function, and quality of life. Although many patients benefit from standard pharmacological therapy, some patients suffer from insufficient treatment response or medication intolerance. Novel treatment approaches are therefore necessary. OBJECTIVE Given the overlap between RLS and pain syndromes in both pathophysiological mechanisms and certain treatment options, we aimed to perform a scoping review of the available evidence on spinal cord stimulation (SCS) for RLS and discuss potential mechanistic implications. METHODS We identified a total of 16 cases of patients with RLS who underwent SCS, all from case reports or case series. DISCUSSION The published evidence is insufficient to assess SCS efficacy in patients with RLS, but SCS remains a promising investigational therapy in RLS on the basis of its potential mitigatory effects in the central hyperexcitability of the sensorimotor cortex through neuromodulation of spinal, subcortical, and cortical areas. A call for further research in this field is presented, with suggestions for future directions and trial designs.
Collapse
Affiliation(s)
- Gabriel L Pagani-Estévez
- Department of Interventional and Surgical Pain Management, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH 45220, United States
| | - Marshall T Holland
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Maja Tippmann-Peikert
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
- Center for Sleep Medicine, Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | | | - Michael H Silber
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
- Center for Sleep Medicine, Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Diego Z Carvalho
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
- Center for Sleep Medicine, Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| |
Collapse
|
4
|
Covassin N, Lu D, St. Louis EK, Chahal AA, Schulte PJ, Mansukhani MP, Xie J, Lipford MC, Li N, Ramar K, Caples SM, Gay PC, Olson EJ, Silber MH, Li J, Somers VK. Sex-specific associations between daytime sleepiness, chronic diseases and mortality in obstructive sleep apnea. Front Neurosci 2023; 17:1210206. [PMID: 37425007 PMCID: PMC10326268 DOI: 10.3389/fnins.2023.1210206] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA) and has been linked to adverse outcomes, albeit inconsistently. Furthermore, whether the prognostic impact of EDS differs as a function of sex is unclear. We aimed to assess the associations between EDS and chronic diseases and mortality in men and women with OSA. Methods Newly-diagnosed adult OSA patients who underwent sleep evaluation at Mayo Clinic between November 2009 and April 2017 and completed the Epworth Sleepiness Scale (ESS) for assessment of perceived sleepiness (N = 14,823) were included. Multivariable-adjusted regression models were used to investigate the relationships between sleepiness, with ESS modeled as a binary (ESS > 10) and as a continuous variable, and chronic diseases and all-cause mortality. Results In cross-sectional analysis, ESS > 10 was independently associated with lower risk of hypertension in male OSA patients (odds ratio [OR], 95% confidence interval [CI]: 0.76, 0.69-0.83) and with higher risk of diabetes mellitus in both OSA men (OR, 1.17, 95% CI 1.05-1.31) and women (OR 1.26, 95% CI 1.10-1.45). Sex-specific curvilinear relations between ESS score and depression and cancer were noted. After a median 6.2 (4.5-8.1) years of follow-up, the hazard ratio for all-cause death in OSA women with ESS > 10 compared to those with ESS ≤ 10 was 1.24 (95% CI 1.05-1.47), after adjusting for demographics, sleep characteristics and comorbidities at baseline. In men, sleepiness was not associated with mortality. Conclusion The implications of EDS for morbidity and mortality risk in OSA are sex-dependent, with hypersomnolence being independently associated with greater vulnerability to premature death only in female patients. Efforts to mitigate mortality risk and restore daytime vigilance in women with OSA should be prioritized.
Collapse
Affiliation(s)
- Naima Covassin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Dongmei Lu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Respiratory and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Erik K. St. Louis
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Anwar A. Chahal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Phillip J. Schulte
- Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Meghna P. Mansukhani
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jiang Xie
- Department of Respiratory and Critical Medicine of Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Melissa C. Lipford
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Nanfang Li
- Center of Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang Hypertension Institute of Xinjiang, Urumqi, China
| | - Kannan Ramar
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sean M. Caples
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Peter C. Gay
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Eric J. Olson
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Michael H. Silber
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jingen Li
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Virend K. Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
5
|
Gossard TR, Teigen LN, Yoo S, Timm PC, Jagielski J, Bibi N, Feemster JC, Steele T, Carvalho DZ, Junna MR, Lipford MC, Tippmann Peikert M, LeClair-Visonneau L, McCarter SJ, Boeve BF, Silber MH, Hirsch J, Sharp RR, St. Louis EK. Patient values and preferences regarding prognostic counseling in isolated REM sleep behavior disorder. Sleep 2023; 46:zsac244. [PMID: 36259668 PMCID: PMC9832520 DOI: 10.1093/sleep/zsac244] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/19/2022] [Indexed: 11/27/2022] Open
Abstract
STUDY OBJECTIVES Isolated REM sleep behavior disorder (iRBD) carries a high lifetime risk for phenoconversion to a defined neurodegenerative disease (NDD) including Parkinson disease, dementia with Lewy bodies, and multiple system atrophy. We aimed to examine iRBD patient values and preferences regarding prognostic counseling. METHODS One hundred thirteen iRBD patient participants enrolled in the Mayo Clinic iRBD Patient Registry were sent an email survey concerning their values and preferences concerning NDD prognostic counseling and their experiences following diagnosis with iRBD. RESULTS Of 81 respondents (71.7% response rate), the majority were men (74.0%) with an average age of 65.7 (±9.7) years. Responses indicated a strong preference toward receiving prognostic information about possible future NDD development. 92.5% of respondents felt knowledge concerning personal NDD risk was important, while 87.6% indicated prognostic discussions were important to maintaining trust in their physician. 95.7% indicated a desire for more information, while only 4.3% desired less information regarding their NDD prognostic risk. Most respondents strongly agreed that prognostic information was important to discuss with their family and friends and inform future life planning, and most expressed interest in learning more about future neuroprotective therapies and symptomatic treatments for parkinsonism and dementia. CONCLUSIONS Most iRBD patients indicated strong preferences for disclosure of NDD prognostic risk and indicated that prognostic information was important for family discussions and future life planning. Future broader surveys and qualitative studies of clinic-based and ultimately community dwelling iRBD patients' values and preferences are needed to guide appropriately tailored and individualized prognostic counseling approaches following iRBD diagnosis.
Collapse
Affiliation(s)
- Thomas R Gossard
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | - Luke N Teigen
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | - Seeley Yoo
- Mayo Center for Sleep Medicine, Minnesota, USA
| | - Paul C Timm
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | | | - Noor Bibi
- Mayo Center for Sleep Medicine, Minnesota, USA
| | - John C Feemster
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Tyler Steele
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Diego Z Carvalho
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
| | | | - Melissa C Lipford
- Mayo Center for Sleep Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Maja Tippmann Peikert
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | | | | | | | - Michael H Silber
- Mayo Center for Sleep Medicine, Minnesota, USA
- Neurology, Minnesota, USA
| | - Jessica Hirsch
- Biomedical Ethics, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Erik K St. Louis
- Mayo Center for Sleep Medicine, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Minnesota, USA
- Departments of Medicine, Minnesota, USA
- Neurology, Minnesota, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, Wisconsin, USA
| |
Collapse
|
6
|
McCarter SJ, Coon EA, Benarroch EE, Silber MH, St Louis EK. Nocturnal Pulse Event Frequency Is Reduced in Multiple System Atrophy. Ann Neurol 2023; 93:205-212. [PMID: 36251404 DOI: 10.1002/ana.26533] [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] [Received: 05/18/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 02/05/2023]
Abstract
Risk of sudden death in multiple system atrophy (MSA) is greatest during sleep with unknown mechanisms. We compared nocturnal pulse event frequency in 46 MSA patients and age-/sex-matched controls undergoing overnight pulse oximetry. Nocturnal oxyhemoglobin desaturation indices and pulse event indices (PEIs) were recorded, and relationships between pulse oximetry variables and survival were analyzed. MSA patients had lower PEI (3.1 ± 5.3 vs. 12.8 ± 10.8, p < 0.001) despite greater hypoxic burden and similar frequency of respiratory events. Nocturnal pulse events were not associated with severity of daytime autonomic failure. Two MSA patients had suspected sudden death, both with severely reduced PEI. MSA patients have fewer nocturnal pulse events compared with controls, despite similar respiratory event frequency, suggesting abnormal cardiac responses to sleep-disordered breathing. Whether this contributes to sudden death in MSA requires further study. ANN NEUROL 2023;93:205-212.
Collapse
Affiliation(s)
- Stuart J McCarter
- Department of Neurology, Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA.,Center for Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Elizabeth A Coon
- Department of Neurology, Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA
| | - Eduardo E Benarroch
- Department of Neurology, Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA
| | - Michael H Silber
- Department of Neurology, Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA.,Center for Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Erik K St Louis
- Department of Neurology, Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, USA.,Center for Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Neurology, Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA.,Department of Clinical and Transational Neurology, Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
| |
Collapse
|
7
|
Sandness DJ, McCarter SJ, Dueffert LG, Shepard PW, Enke AM, Fields J, Mielke MM, Boeve BF, Silber MH, St. Louis EK. Cognition and driving ability in isolated and symptomatic REM sleep behavior disorder. Sleep 2022; 45:zsab253. [PMID: 34958375 PMCID: PMC8996024 DOI: 10.1093/sleep/zsab253] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/28/2021] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES To analyze cognitive deficits leading to unsafe driving in patients with REM Sleep Behavior Disorder (RBD), strongly associated with cognitive impairment and synucleinopathy-related neurodegeneration. METHODS Twenty isolated RBD (iRBD), 10 symptomatic RBD (sRBD), and 20 age- and education-matched controls participated in a prospective case-control driving simulation study. Group mean differences were compared with correlations between cognitive and driving safety measures. RESULTS iRBD and sRBD patients were more cognitively impaired than controls in global neurocognitive functioning, processing speeds, visuospatial attention, and distractibility (p < .05). sRBD patients drove slower with more collisions than iRBD patients and controls (p < .05), required more warnings, and had greater difficulty following and matching speed of a lead car during simulated car-following tasks (p < .05). Driving safety measures were similar between iRBD patients and controls. Slower psychomotor speed correlated with more off-road accidents (r = 0.65) while processing speed (-0.88), executive function (-0.90), and visuospatial impairment (0.74) correlated with safety warnings in sRBD patients. Slower stimulus recognition was associated with more signal-light (0.64) and stop-sign (0.56) infractions in iRBD patients. CONCLUSIONS iRBD and sRBD patients have greater selective cognitive impairments than controls, particularly visuospatial abilities and processing speed. sRBD patients exhibited unsafe driving behaviors, associated with processing speed, visuospatial awareness, and attentional impairments. Our results suggest that iRBD patients have similar driving-simulator performance as healthy controls but that driving capabilities regress as RBD progresses to symptomatic RBD with overt signs of cognitive, autonomic, and motor impairment. Longitudinal studies with serial driving simulator evaluations and objective on-road driving performance are needed.
Collapse
Affiliation(s)
- David J Sandness
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
| | - Stuart J McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Lucas G Dueffert
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Park Nicollet Rehabilitation, Maple Grove, MN, USA
| | - Paul W Shepard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
| | - Ashley M Enke
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
| | - Julie Fields
- Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michael H Silber
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
| |
Collapse
|
8
|
Gali B, Silber MH, Hanson AC, Portner E, Gay P. Perioperative outcomes of patients with restless leg syndrome: a single center retrospective review. J Clin Sleep Med 2022; 18:1841-1846. [PMID: 35393939 DOI: 10.5664/jcsm.10000] [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] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES There are multiple stressors in the perioperative period for patients with restless leg syndrome (RLS) that may by implicated in the worsening of symptoms. Our primary objective was to compare the perioperative course of patients with RLS to patients without the diagnosis. METHODS This was a single-center, matched cohort, retrospective chart review of patients with RLS undergoing inpatient procedures from 2015 to 2019 matched 1:1 with patients without the diagnosis. RESULTS Patients with RLS had a higher comorbidity burden specifically pulmonary, renal, diabetes mellitus, and congestive heart failure. The perioperative course was notable for higher maximum pain scores for RLS patients in the post-anesthesia care unit (PACU) (OR 1.29, 95% CI 1.19-1.40, p < 0.001). Postoperative RLS patients also had higher maximum pain scores on postoperative days 0, 1 and 2. Odds of rapid response calls were higher in RLS patients (OR 1.43, 95% CI 1.18 to 1.73, p < 0.001). There were no other significant differences in postoperative complications. The odds of using RLS triggering medications was lower in the RLS group (OR 0.85, 95% CI 0.78-0.92, p < 0.001). CONCLUSIONS Our single center retrospective review found that patients with RLS had higher pain scores in the PACU and on the first few postoperative days. Rapid response team calls were more common in patients with RLS. RLS-triggering medications were significantly less likely to be used in patients with RLS. There were no significant differences in other postoperative events.
Collapse
Affiliation(s)
- Bhargavi Gali
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester MN
| | - Michael H Silber
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic, Rochester MN
| | - Andrew C Hanson
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester MN
| | - Erica Portner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester MN
| | - Peter Gay
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mayo Clinic, Rochester MN
| |
Collapse
|
9
|
Feemster JC, Steele TA, Palermo KP, Ralston CL, Tao Y, Bauer DA, Edgar L, Rivera S, Walters-Smith M, Gossard TR, Teigen LN, Timm PC, Richardson JW, Robert Auger R, Kolla B, McCarter SJ, Boeve BF, Silber MH, St. Louis EK. Abnormal rapid eye movement sleep atonia control in chronic post-traumatic stress disorder. Sleep 2021; 45:6484914. [PMID: 34958372 PMCID: PMC8919203 DOI: 10.1093/sleep/zsab259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/12/2021] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES Post-traumatic stress disorder (PTSD) and rapid eye movement (REM) sleep behavior disorder (RBD) share some common features including prominent nightmares and sleep disturbances. We aimed to comparatively analyze REM sleep without atonia (RSWA) between patients with chronic PTSD with and without dream enactment behavior (DEB), isolated RBD (iRBD), and controls. METHODS In this retrospective study, we comparatively analyzed 18 PTSD with DEB (PTSD+DEB), 18 PTSD without DEB, 15 iRBD, and 51 controls matched for age and sex. We reviewed medical records to determine PTSD clinical features and quantitatively analyzed RSWA. We used nonparametric analyses to compare clinical and polysomnographic features. RESULTS PTSD patients, both with and without DEB, had significantly higher RSWA than controls (all p < .025, excepting submentalis phasic duration in PTSD+DEB). Most RSWA measures were also higher in PTSD+DEB than in PTSD without DEB patients (all p < .025). CONCLUSIONS PTSD patients have higher RSWA than controls, whether DEB is present or not, indicating that REM sleep atonia control is abnormal in chronic PTSD. Further prospective studies are needed to determine whether neurodegenerative risk and disease markers similar to RBD might occur in PTSD patients.
Collapse
Affiliation(s)
- John C Feemster
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Tyler A Steele
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Kyle P Palermo
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Christy L Ralston
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Cornell College, Mount Vernon, IA, USA
| | - Yumeng Tao
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Cornell College, Mount Vernon, IA, USA
| | - David A Bauer
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Liam Edgar
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Sonia Rivera
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Maxwell Walters-Smith
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas R Gossard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Luke N Teigen
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Paul C Timm
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Jarrett W Richardson
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - R Robert Auger
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bhanuprakash Kolla
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Stuart J McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michael H Silber
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA,Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA,Corresponding author. Erik K. St. Louis, Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
10
|
Devine MF, Feemster JC, Lieske EA, McCarter SJ, Sandness DJ, Steele T, Timm PC, Mandrekar J, Boeve BF, Silber MH, Dubey D, McKeon A, St. Louis EK. Objective sleep profile in LGI1/CASPR2 autoimmunity. Sleep 2021; 45:6483058. [PMID: 34953167 PMCID: PMC8842336 DOI: 10.1093/sleep/zsab297] [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: 03/26/2021] [Revised: 07/19/2021] [Indexed: 12/27/2022] Open
Abstract
STUDY OBJECTIVES Rapid eye movement (REM) sleep behavior disorder (RBD) and other sleep disturbances are frequent in leucine-rich, glioma inactivated protein 1-IgG (LGI1) and contactin-associated protein 2-IgG (CASPR2) autoimmunity, yet polysomnographic analyses of these disorders remain limited. We aimed to characterize clinical presentations and analyze polysomnographic manifestations, especially quantitative REM sleep without atonia (RSWA) in LGI1/CASPR2-IgG seropositive (LGI/CASPR2+) patients. METHODS We retrospectively analyzed clinical and polysomnographic features and quantitative RSWA between LGI1+/CASPR2+ patients and age-sex matched controls. Groups were compared with Wilcoxon rank-sum and chi-square tests. Combined submentalis and anterior tibialis (SM + AT) RSWA was the primary outcome. RESULTS Among 11 (LGI1+, n = 9; CASPR2+, n = 2) patients, Morvan syndrome sleep features were present in seven (63.6%) LGI1+/CASPR2+ patients, with simultaneous insomnia and dream enactment behavior (DEB) in three (27.3%), and the most common presenting sleep disturbances were DEB (n = 5), insomnia (n = 5), and sleep apnea (n = 8; median apnea-hypopnea index = 15/hour). Median Epworth Sleepiness Scale was nine (range 3-24; n = 10), with hypersomnia in four (36.4%). LGI1+/CASPR2+ patients had increased N1 sleep (p = .02), decreased REM sleep (p = .001), and higher levels of SM + AT any RSWA (p < .001). Eight of nine (89%) LGI1+ exceeded RBD RSWA thresholds (DEB, n = 5; isolated RSWA, n = 3). RSWA was greater in AT than SM. All 10 LGI1+/CASPR2+ patients treated with immunotherapy benefitted, and 5/10 had improved sleep disturbances. CONCLUSIONS LGI1/CASPR2-IgG autoimmunity is associated with prominent dream enactment, insomnia, RSWA, sleep apnea, and shallower sleep. Polysomnography provides objective disease markers in LGI1+/CASPR2+ autoimmunity and immunotherapy may benefit associated sleep disturbances.
Collapse
Affiliation(s)
- Michelle F Devine
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA,Olmsted Medical Center, Rochester, MN, USA
| | - John C Feemster
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Elizabeth A Lieske
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Stuart J McCarter
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA,Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Clinic and Foundation, Rochester, MN, USA
| | - David J Sandness
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Tyler Steele
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Paul C Timm
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Jay Mandrekar
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Biostatistics, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michael H Silber
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Pathology/Laboratory Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Pathology/Laboratory Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St. Louis
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA,Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Clinic and Foundation, Rochester, MN, USA,Mayo Clinic Health System Southwest Wisconsin-La Crosse, Mayo Clinic and Foundation, Rochester, MN, USA,Corresponding author. Erik K. St. Louis, Mayo Sleep Behavior and Neurophysiology Research Laboratory, Division of Sleep Neurology, Mayo Clinic Southwest Wisconsin-La-Crosse, Mayo Clinic College of Medicine and Science, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
11
|
Miyagawa T, Przybelski SA, Maltais DD, Min H, Jordan L, Lesnick TG, St. Louis EK, Silber MH, Graff‐Radford J, Jones DT, Savica R, Knopman DS, Petersen RC, Kremers WK, Forsberg LK, Fields JA, Ferman TJ, Allen LA, Kantarci K, Lowe VJ, Boeve BF. Potential utility of longitudinal
123
I‐FP‐CIT SPECT imaging in predicting phenoconversion to overt synucleinopathy in isolated REM sleep behavior disorder. Alzheimers Dement 2021. [DOI: 10.1002/alz.056563] [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: 11/09/2022]
|
12
|
Forsberg LK, Syrjanen JA, Ferman TJ, Boeve BF, Miyagawa T, Graff‐Radford NR, Knopman DS, Graff‐Radford J, Savica R, Savica R, Jones DT, Fields JA, Lucas JA, Allen LA, St. Louis EK, Silber MH, Petersen RC. Brief smell identification test performance in RBD, DLB and AD. Alzheimers Dement 2021. [DOI: 10.1002/alz.055830] [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: 11/06/2022]
|
13
|
Silber MH, Buchfuhrer MJ, Earley CJ, Koo BB, Manconi M, Winkelman JW. The Management of Restless Legs Syndrome: An Updated Algorithm. Mayo Clin Proc 2021; 96:1921-1937. [PMID: 34218864 DOI: 10.1016/j.mayocp.2020.12.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 01/26/2023]
Abstract
Restless legs syndrome (RLS) is a common disorder. The population prevalence is 1.5% to 2.7% in a subgroup of patients having more severe RLS with symptoms occurring 2 or more times a week and causing at least moderate distress. It is important for primary care physicians to be familiar with the disorder and its management. Much has changed in the management of RLS since our previous revised algorithm was published in 2013. This updated algorithm was written by members of the Scientific and Medical Advisory Board of the RLS Foundation based on scientific evidence and expert opinion. A literature search was performed using PubMed identifying all articles on RLS from 2012 to 2020. The management of RLS is considered under the following headings: General Considerations; Intermittent RLS; Chronic Persistent RLS; Refractory RLS; Special Circumstances; and Alternative, Investigative, and Potential Future Therapies. Nonpharmacologic approaches, including mental alerting activities, avoidance of substances or medications that may exacerbate RLS, and oral and intravenous iron supplementation, are outlined. The choice of an alpha2-delta ligand as first-line therapy for chronic persistent RLS with dopamine agonists as a second-line option is explained. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS and describe management approaches, including combination therapy and the use of high-potency opioids. Treatment of RLS in pregnancy and childhood is discussed.
Collapse
Affiliation(s)
- Michael H Silber
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - Mark J Buchfuhrer
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, CA
| | - Christopher J Earley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian B Koo
- Department of Neurology, Yale University, New Haven, CT
| | - Mauro Manconi
- Sleep Medicine, Neurocenter of Southern Switzerland, Ospedale Civico, and Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - John W Winkelman
- Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Cambridge, MA
| | | |
Collapse
|
14
|
Abstract
Excessive daytime sleepiness (EDS) is a highly prevalent condition that is associated with significant morbidity. The causes of EDS are varied, and include inadequate sleep, sleep disordered breathing, circadian rhythm sleep-wake disorders, and central disorders of hypersomnolence (narcolepsy, idiopathic hypersomnia, and Kleine-Levin syndrome). Additionally, EDS could represent a symptom of an underlying medical or psychiatric disorder. Assessment of EDS includes a thorough sleep, medical, and psychiatric history, targeted clinical examination, and appropriate use of actigraphy to measure sleep duration and sleep-wake patterns, polysomnography to assess for associated conditions such as sleep-related breathing disorders or other factors that might disrupt nighttime sleep, multiple sleep latency testing to ascertain objective sleepiness and diagnose central disorders of hypersomnolence, and measurement of cerebrospinal fluid hypocretin-1 concentration. Treatment of EDS secondary to central disorders of hypersomnolence is primarily pharmacologic with wakefulness-promoting agents such as modafinil, stimulants such as methylphenidate and amphetamines, and newer agents specifically designed to improve wakefulness; behavioral interventions can provide a useful adjunct to pharmacologic treatment. When excessive sleepiness is secondary to other conditions, the treatment should focus on targeting the primary disorder. This review discusses current epidemiology, provides guidance on clinical assessments and testing, and discusses the latest treatment options. For this review, we collated the latest evidence using the search terms excessive sleepiness, hypersomnia, hypersomnolence, treatment from PubMed and MEDLINE and the latest practice parameters from the American Academy of Sleep Medicine.
Collapse
Affiliation(s)
- Kriti D Gandhi
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Michael H Silber
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Bhanu Prakash Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Center for Sleep Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
15
|
Teigen LN, Sharp RR, Hirsch JR, Campbell E, Timm PC, Sandness DJ, Feemster JC, Gossard TR, Faber SM, Steele TA, Rivera S, Junna MR, Lipford MC, Tippmann-Peikert M, Kotagal S, Ju YE, Howell M, Schenck CH, Videnovic A, Jennum P, Hogl B, Stefani A, Arnulf I, Heidbreder A, Lewis S, McCarter SJ, Boeve BF, Silber MH, St Louis EK. Specialist approaches to prognostic counseling in isolated REM sleep behavior disorder. Sleep Med 2020; 79:107-112. [PMID: 33486257 PMCID: PMC10075000 DOI: 10.1016/j.sleep.2020.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES/BACKGROUND Most middle-aged and older adult patients with isolated (idiopathic) REM sleep behavior disorder (RBD) eventually develop parkinsonism, dementia with Lewy bodies, or multiple system atrophy. We aimed to describe the current sleep medicine specialist approach toward RBD prognostic counseling, and to determine physician beliefs and characteristics that impact provision of counseling. PATIENTS/METHODS We surveyed 70 sleep medicine physicians with RBD expertise for demographic information, counseling practices, and their beliefs and understandings concerning the association between RBD and synucleinopathies, among other questions. Responses were summarized by descriptive statistics. RESULTS Among the 44 respondents (63% response rate), 41 (93.2%) regularly provided prognostic counseling for most RBD patients, but only 31.8% routinely asked about patient preferences on receiving counseling. 41.8% believed that the risk for developing overt synucleinopathy following RBD diagnosis was >80%, but only 15.9% routinely provided this detailed phenoconversion risk estimate to their patients. Most respondents were concerned that RBD prognostic counseling could adversely impact on the patient's and family's mental health. CONCLUSIONS Most expert RBD sleep clinicians routinely counsel their patients regarding the high risk for phenoconversion to parkinsonism or dementia, yet relatively few routinely ask patients about their preferences for receiving this information, and fewer provide details concerning the known high risk estimates for developing a synucleinopathy. Future research should analyze patients' values and preferences in RBD populations to inform approaches toward shared decision making for RBD prognostic counseling.
Collapse
Affiliation(s)
- Luke N Teigen
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jessica R Hirsch
- Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Emmaling Campbell
- Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; University of South Carolina, USA
| | - Paul C Timm
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David J Sandness
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John C Feemster
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Thomas R Gossard
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sarah M Faber
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Tyler A Steele
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; University of Minnesota-Rochester, Rochester, MN, USA
| | - Sonia Rivera
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; University of Minnesota-Rochester, Rochester, MN, USA
| | - Mithri R Junna
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Melissa C Lipford
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Maja Tippmann-Peikert
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Suresh Kotagal
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Yo-El Ju
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Michael Howell
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, And Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Poul Jennum
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Hogl
- Department of Neurology, University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, University of Innsbruck, Innsbruck, Austria
| | - Isabelle Arnulf
- Pitie Salpetriere Hopital and Sorbonne University, Paris, France
| | - Anna Heidbreder
- Department of Neurology, University of Innsbruck, Innsbruck, Austria; Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Simon Lewis
- Department of Neurology, University of Sidney, Sidney, Australia
| | - Stuart J McCarter
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michael H Silber
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| |
Collapse
|
16
|
Choudhury P, Radford JG, Wurtz L, Aakre JA, Brushaber D, Jones DT, Knopman DS, Kantarci K, Savica R, Graff‐Radford NR, Drubach DA, Fields JA, Machulda MM, Pedraza O, Forsberg LK, Allen LA, Miyagawa T, St. Louis EK, Silber MH, Kremers WK, Petersen RC, Boeve BF, Ferman TJ. Evolution of the core clinical features of dementia with Lewy bodies. Alzheimers Dement 2020. [DOI: 10.1002/alz.044307] [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: 11/07/2022]
|
17
|
Gossard TR, McCarter SJ, Gorres E, Feemster JC, Timm PC, Teigen LN, Ralston CL, Westerland SM, Conway JP, Jagielski JT, Olson CD, Edgar LJ, Veum EL, Savica R, Boeve BF, Silber MH, St Louis EK. Quantitative REM Sleep without Atonia in Parkinson's Disease and Essential Tremor. Mov Disord Clin Pract 2020; 8:37-43. [PMID: 33426157 DOI: 10.1002/mdc3.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 11/08/2022] Open
Abstract
Background Rapid eye movement (REM) sleep behavior disorder (RBD) occurs occasionally in essential tremor (ET), but polysomnographic REM sleep without atonia (RSWA) analyses have been sparse. Objective To characterize the amount and distribution of polysomnographic RSWA, the electrophysiologic substrate of RBD, in patients with Parkinson's disease (PD) and ET. Methods We analyzed quantitative RSWA in 73 patients: PD (23), ET (23), and age-sex-matched controls (27). None had dream-enactment behavior history or received antidepressants. Phasic, tonic, "any," and phasic-burst duration RSWA measures were calculated in the submentalis (SM) and anterior tibialis (AT) muscles. The automated REM atonia index (RAI) was also determined. Statistical analysis was performed by Kruskal-Wallis rank-sum and Mann-Whitney tests. Results SM phasic RSWA was significantly greater for PD than ET patients and controls (12.5% ± 12.8% vs. 4.9% ± 6.7%, 3.9% ± 2.6%), as was SM "any" (13.54% ± 14.30% vs. 5.2% ± 7.6%, 4.2% ± 2.6%). RAI was significantly lower in PD than in ET and controls (0.78 ± 0.23 vs. 0.92 ± 0.09 vs. 0.90 ± 0.17, P ≤ 0.005), but no different between ET and controls. AT phasic and "any" RSWA was similar between the 3 groups. ET and control RSWA was similar in all measures. Two ET patients (8.7%) had SM RSWA similar to PD patients. Conclusions Elevated SM RSWA distinguished PD from ET in patients without dream-enactment symptoms and occurs frequently in PD patients, and in isolated tremor suggests underlying synucleinopathy. Prospective studies will further validate these findings.
Collapse
Affiliation(s)
- Thomas R Gossard
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - Stuart J McCarter
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Department of Neurology Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - Evan Gorres
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - John C Feemster
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - Paul C Timm
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - Luke N Teigen
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - Christy L Ralston
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Cornell College Mount Vernon Iowa USA
| | - Sarah M Westerland
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - Jimmy P Conway
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Luther College Decorah Iowa USA
| | - Jack T Jagielski
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Luther College Decorah Iowa USA
| | - Carl D Olson
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,St. Olaf College Northfield Minnesota USA
| | - Liam J Edgar
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,St. Olaf College Northfield Minnesota USA
| | - Emma L Veum
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Luther College Decorah Iowa USA
| | - Rodolfo Savica
- Department of Neurology Mayo Clinic College of Medicine and Science Rochester Minnesota USA.,Department of Health Science Research Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - Brad F Boeve
- Department of Neurology Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - Michael H Silber
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Department of Neurology Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - Erik K St Louis
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Department of Neurology Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| |
Collapse
|
18
|
Kolla BP, Jahani Kondori M, Silber MH, Samman H, Dhankikar S, Mansukhani MP. Advance taper of antidepressants prior to multiple sleep latency testing increases the number of sleep-onset rapid eye movement periods and reduces mean sleep latency. J Clin Sleep Med 2020; 16:1921-1927. [DOI: 10.5664/jcsm.8738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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)
- Bhanu Prakash Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Hala Samman
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Swati Dhankikar
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Meghna P. Mansukhani
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW This article discusses the clinical manifestations, diagnosis and differential diagnosis, pathophysiology, and management of parasomnias occurring in non-rapid eye movement (REM) sleep. RECENT FINDINGS Disorders of arousal are characterized by dissociated sleep, with wake and sleep phenomena intermingling, and local sleep, in which different areas of the brain exist simultaneously in different states of wakefulness or sleep. The frequency of arousals from slow-wave sleep with delta or mixed-frequency activity has a high sensitivity but relatively low specificity for the diagnosis of arousal parasomnias. SUMMARY Disorders of arousal (sleepwalking, sleep terrors, and confusional arousals) are characterized by incomplete awakenings from slow-wave sleep, limited recall of imagery, and partial or complete amnesia. They occur most frequently in childhood. Management includes correction of precipitating factors, attention to safety, behavioral techniques, and medications. Sleep-related eating disorder is a variant of arousal disorders and may be associated with the use of short-acting hypnotics and restless legs syndrome. Complex nocturnal visual hallucinations can occur with visual loss, dementia with Lewy bodies, use of β-adrenergic receptor antagonists, and anxiety. Exploding head syndrome occurs at wake-sleep transition or on waking during the night, is usually benign, and requires treatment only if significant sleep disruption occurs.
Collapse
|
20
|
|
21
|
McCarter SJ, Gehrking TL, St Louis EK, Suarez MD, Boeve BF, Silber MH, Low PA, Singer W. Autonomic dysfunction and phenoconversion in idiopathic REM sleep behavior disorder. Clin Auton Res 2020; 30:207-213. [PMID: 32193800 PMCID: PMC7255960 DOI: 10.1007/s10286-020-00674-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND REM sleep behavior disorder (RBD) is a common finding among patients with synucleinopathies. We aimed to determine the degree of autonomic dysfunction in patients presenting with idiopathic RBD (iRBD), and the predictive value of autonomic dysfunction for phenoconversion to a defined neurodegenerative disease. METHODS We searched our electronic medical record for patients diagnosed with iRBD who also underwent standardized autonomic function testing within 6 months of iRBD diagnosis, and who had clinical follow-up of at least 3 years following iRBD diagnosis. The composite autonomic severity score (CASS) was derived and compared between phenoconverters and non-converters using chi-square and Wilcoxon rank-sum tests. RESULTS We identified 18 patients who fulfilled inclusion and exclusion criteria. Average age at autonomic testing was 67 ± 6.6 years. Twelve (67%) patients phenoconverted during the follow-up period; six developed Parkinson's disease (PD), and the other six, dementia with Lewy bodies (DLB). Fifteen (83%) patients had at least mild autonomic dysfunction. There were no significant differences between overall converters and non-converters in total CASS or CASS subscores. However, iRBD patients who developed DLB had significantly higher total and cardiovagal CASS scores compared with those who developed PD (p < 0.05), and a trend for higher adrenergic CASS scores compared to those who developed PD and those who did not phenoconvert. DISCUSSION Autonomic dysfunction was seen in 83% of iRBD patients, and more severe baseline cardiovagal autonomic dysfunction in iRBD was associated with phenoconversion to DLB but not PD. Prospective studies are needed to confirm the value of autonomic testing for predicting phenoconversion and disease phenotype in iRBD.
Collapse
Affiliation(s)
- Stuart J McCarter
- Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Tonette L Gehrking
- Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Erik K St Louis
- Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
- Department of Medicine, Mayo Clinic, Rochester, USA
- Department of Sleep Medicine, Mayo Clinic, Rochester, USA
| | - Mariana D Suarez
- Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
- Department of Sleep Medicine, Mayo Clinic, Rochester, USA
| | - Michael H Silber
- Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
- Department of Sleep Medicine, Mayo Clinic, Rochester, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
| |
Collapse
|
22
|
Krahn LE, Tashman YS, Lyng PJ, Lloyd RM, Silber MH. 0799 A Population-based Study of Adult Patients With Recurrent, Clinician Diagnosed Sleepwalking and/or Sleep Related Eating Disorder. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.795] [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
The ICSD-3 describes NREM-related parasomnias as abnormal sleep related complex movements where motor behavior occurs in the setting of absent or very minimal higher cognitive function. A population-based twin study reported that 3.9% of men and 3.1 % of women sleepwalk (SW) with 30% reported experiencing injury (Hublin 1997). Sleep related eating disorder (SRED) may be a variant of SW with a reported prevalence of 0.5-5 % (Michalska 2016). This study examined SW and SRED in a population-based sample permitting review of associated features, risk factors and outcomes.
Methods
The records-linkage system of the Rochester Epidemiology Project that includes all adults residing in Olmsted County MN was searched for documentation of patients seeking care for at least two episodes of sleepwalking and/or sleep eating. Records from 2007-2016 were included.
Results
56 cases were identified with 50 (89 %) having SW and 16 (29%) SRED. The gender breakdown was 50% male and 50% female with the mean age at diagnosis of 40 (SD 13). Childhood parasomnia events were reported by 23/36 (62%) and a family history in 21/35 (64%). Data were unavailable for the others. The number of parasomnia incidents was ≥ 10 for 21 (37%). A variety of experiences were documented, including leaving the bedroom (39%), injury (25%), and exiting through a window/balcony (5%). Associated factors were sleep deprivation (52%), untreated obstructive sleep apnea (34%), antidepressant use (41%), zolpidem use (18%), circadian disruption (14%) and alcohol use (9%). Polysomnography was conducted for 41 (74%). Documented interventions were medication discontinuation (18%) and starting a benzodiazepine (16%). In 21%, no treatment was given.
Conclusion
This population-based study of adults with clinician diagnosed recurrent SW and SRED revealed equal rates in men and women. The majority of patients with SRED also had SW. 25% of cases were associated with injuries.
Support
Rochester Epidemiology Project supported by NIH R01 AG034676 and AG052425 and the Mayo Foundation.
Collapse
|
23
|
Devine MF, Feemster JC, Lieske EA, McCarter SJ, Sandness DJ, Steele T, Boeve BF, Silber MH, McKeon A, St. Louis EK. 0003 LGI1 and CASPR2 Autoimmunity: Sleep Symptoms, Polysomnography, and Quantitative REM Sleep without Atonia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Sleep disturbances, including rapid eye movement (REM) behavior disorder (RBD), are known manifestations of voltage-gated-potassium-channel-complex VGKC-IgG seropositivity (VGKC+). Discovery of leucine-rich, glioma inactivated protein 1 (LGI1) and contactin-associated protein 2 (CASPR2) have refined our understanding of VGKC+. VGKC+ without LGI1/CASPR2-IgG (“double-negative”) has lost its clinical significance. Previous detailed sleep analysis of these subtypes has been limited.
Methods
We performed a retrospective study to characterize clinical and polysomnographic features of LGI1/CASPR2 seropositive (LGI1+/CASPR2+) and VGKC double-negative patients, including quantitative REM sleep without atonia (RSWA). Quantified RSWA was compared to matched controls and normative RSWA percentiles.
Results
Eleven LGI1+/CASPR2+ (LGI1+, 9) and twelve VGKC double-negative patients were analyzed. Insomnia was seen in 55% of LGI1+/CASPR2+ and 8% of VGKC double-negative patients (p=0.05). The LGI1+/CASPR2+ group had reduced slow wave sleep compared to the VGKC double-negative group. Five LGI1+ patients had clinical dream enactment behavior (DEB). Eight LGI1+ patients met quantitative diagnostic levels of RSWA. Higher RSWA levels were seen in the LGI1+/CASPR2+ group. Ten LGI1+/CASPR2+ patients received immunotherapy; all ten neurologically benefited with sleep benefits in 6/10.
Conclusion
Sleep disorders such as insomnia and RBD are part of the LGI1/CASPR2 autoimmune phenotype. Objective sleep manifestations can be seen on polysomnogram in the form of reduced N3 and elevated RSWA as compared to controls. Quantitative RSWA analysis identified RBD in more LGI1+ patients than clinical report or qualitative RSWA. In this study, RBD was only seen with LGI1+, not CASPR2+. The intermediate RSWA levels of the VGKC double-negative patients may suggest a spectrum of abnormal motor activity in these related antibodies. Additional studies are needed to further explore the biomarker potential of quantitative RSWA in autoimmune neurological conditions.
Support
This project was supported by the National Center forResearch Resources, National Institutes of Health, through Grant Number 1 UL1 RR024150- 01.
Collapse
|
24
|
Feemster JC, Jung Y, Timm PC, Westerland SM, Gossard TR, Teigen LN, Buchal LA, Cattaneo EFD, Imlach CA, Mccarter SJ, Smith KL, Boeve BF, Silber MH, St Louis EK. Normative and isolated rapid eye movement sleep without atonia in adults without REM sleep behavior disorder. Sleep 2020; 42:5581967. [PMID: 31587043 DOI: 10.1093/sleep/zsz124] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
STUDY OBJECTIVES Values for normative REM sleep without atonia (RSWA) remain unclear. Older age and male sex are associated with greater RSWA, and isolated elevated RSWA has been reported. We aimed to describe normative RSWA and characterize isolated RSWA frequency in adults without REM sleep behavior disorder (RBD). METHODS We visually quantified phasic, "any," and tonic RSWA in the submentalis (SM) and anterior tibialis (AT) muscles, and the automated Ferri REM Atonia Index during polysomnography in adults without RBD aged 21-88. We calculated RSWA percentiles across age and sex deciles and compared RSWA in older (≥ 65) versus younger (<65) men and women. Isolated RSWA (exceeding diagnostic RBD cutoffs, or >95th percentile) frequency was also determined. RESULTS Overall, 95th percentile RSWA percentages were SM phasic, any, tonic = 8.6%, 9.1%, 0.99%; AT phasic and "any" = 17.0%; combined SM/AT phasic, "any" = 22.3%, 25.5%; and RAI = 0.85. Most phasic RSWA burst durations were ≤1.0 s (85th percentiles: SM = 1.07, AT = 0.86 seconds). Older men had significantly higher AT RSWA than older women and younger patients (all p < 0.04). Twenty-nine (25%, 18 men) had RSWA exceeding the cohort 95th percentile, while 17 (14%, 12 men) fulfilled diagnostic cutoffs for phasic or automated RBD RSWA thresholds. CONCLUSIONS RSWA levels are highest in older men, mirroring the demographic characteristics of RBD, suggesting that older men frequently have altered REM sleep atonia control. These data establish normative adult RSWA values and thresholds for determination of isolated RSWA elevation, potentially aiding RBD diagnosis and discussions concerning incidental RSWA in clinical sleep medicine practice.
Collapse
Affiliation(s)
- John C Feemster
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Youngsin Jung
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Paul C Timm
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Sarah M Westerland
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Thomas R Gossard
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Luke N Teigen
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Lauren A Buchal
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Elena F D Cattaneo
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Charlotte A Imlach
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Stuart J Mccarter
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Kevin L Smith
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Bradley F Boeve
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Michael H Silber
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | | |
Collapse
|
25
|
McCarter SJ, Tabatabai GM, Jong HY, Sandness DJ, Timm PC, Johnson KL, McCarter AR, Savica R, Vemuri P, Machulda MM, Kantarci K, Mielke MM, Boeve BF, Silber MH, St Louis EK. REM sleep atonia loss distinguishes synucleinopathy in older adults with cognitive impairment. Neurology 2019; 94:e15-e29. [PMID: 31831602 DOI: 10.1212/wnl.0000000000008694] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/28/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine whether quantitative polysomnographic REM sleep without atonia (RSWA) distinguishes between cognitive impairment phenotypes. BACKGROUND Neurodegenerative cognitive impairment in older adults predominantly correlates with tauopathy or synucleinopathy. Accurate antemortem phenotypic diagnosis has important prognostic and treatment implications; additional clinical tools might distinguish between dementia syndromes. METHODS We quantitatively analyzed RSWA in 61 older adults who underwent polysomnography including 46 with cognitive impairment (20 probable synucleinopathy), 26 probable non-synucleinopathy (15 probable Alzheimer disease, 11 frontotemporal lobar dementia), and 15 age- and sex-matched controls. Submentalis and anterior tibialis RSWA metrics and automated REM atonia index were calculated. Group statistical comparisons and regression were performed, and receiver operating characteristic curves determined diagnostic RSWA thresholds that best distinguished synucleinopathy phenotype. RESULTS Submentalis-but not anterior tibialis RSWA-was greater in synucleinopathy than nonsynucleinopathy; several RSWA diagnostic thresholds distinguished synucleinopathy with excellent specificity including submentalis tonic, 5.6% (area under the curve [AUC] 0.791); submentalis any, 15.0% (AUC 0.871); submentalis phasic, 10.8% (AUC 0.863); and anterior tibialis phasic, 31.4% (AUC 0.694). In the subset of patients without dream enactment behaviors, submentalis RSWA was also greater in patients with synucleinopathy than in those without synucleinopathy. RSWA was detected more frequently by quantitative than qualitative methods (p = 0.0001). CONCLUSION Elevated submentalis RSWA distinguishes probable synucleinopathy from probable nonsynucleinopathy in cognitively impaired older adults, even in the absence of clinical dream enactment symptoms. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that quantitative RSWA analysis is useful for distinguishing cognitive impairment phenotypes. Further studies with pathologic confirmation of dementia diagnoses are needed to confirm the diagnostic utility of RSWA in dementia.
Collapse
Affiliation(s)
- Stuart J McCarter
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Grace M Tabatabai
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Ho-Yann Jong
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - David J Sandness
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Paul C Timm
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Katie L Johnson
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Allison R McCarter
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Rodolfo Savica
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Prashanthi Vemuri
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Mary M Machulda
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Kejal Kantarci
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Michelle M Mielke
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Bradley F Boeve
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Michael H Silber
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Erik K St Louis
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.).
| |
Collapse
|
26
|
McCarter SJ, Feemster JC, Tabatabai GM, Sandness DJ, Timm PC, McCarter AR, Talley HN, Junna MR, Savica R, Singer W, Coon EA, Benarroch EE, Josephs KA, Boeve BF, Silber MH, St. Louis EK. Submentalis Rapid Eye Movement Sleep Muscle Activity: A Potential Biomarker for Synucleinopathy. Ann Neurol 2019; 86:969-974. [DOI: 10.1002/ana.25622] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Stuart J. McCarter
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
- Department of MedicineMayo Clinic College of Medicine and Science Rochester MN
| | - John C. Feemster
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - Grace M. Tabatabai
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - David J. Sandness
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - Paul C. Timm
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - Allison R. McCarter
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - Heather N. Talley
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
| | - Mithri R. Junna
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
- Department of MedicineMayo Clinic College of Medicine and Science Rochester MN
| | - Rodolfo Savica
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of Health Science ResearchMayo Clinic College of Medicine and Science Rochester MN
| | - Wolfgang Singer
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
| | - Elizabeth A. Coon
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
| | | | - Keith A. Josephs
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
| | - Bradley F. Boeve
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
| | - Michael H. Silber
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
| | - Erik K. St. Louis
- Mayo Center for Sleep Medicine, Mayo Clinic College of Medicine and Science Rochester MN
- Department of NeurologyMayo Clinic College of Medicine and Science Rochester MN
- Department of MedicineMayo Clinic College of Medicine and Science Rochester MN
| |
Collapse
|
27
|
McCarter SJ, Sandness DJ, McCarter AR, Feemster JC, Teigen LN, Timm PC, Boeve BF, Silber MH, St Louis EK. REM sleep muscle activity in idiopathic REM sleep behavior disorder predicts phenoconversion. Neurology 2019; 93:e1171-e1179. [PMID: 31420463 DOI: 10.1212/wnl.0000000000008127] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/24/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether REM sleep without atonia (RSWA) during polysomnography (PSG) predicts phenoconversion in patients with idiopathic REM sleep behavior disorder (iRBD), a prodromal feature of a neurodegenerative disease. METHODS We analyzed RSWA in 60 patients with iRBD, including manual phasic, tonic, and any muscle activity in the submentalis and anterior tibialis muscles and the automated REM atonia index in the submentals. We identified patients who developed parkinsonism or mild cognitive impairment (MCI) during at least 3 years of follow-up after PSG. Kaplan-Meier analysis was performed and receiver operator curves were calculated to determine RSWA cutoffs predicting faster phenoconversion. RESULTS Twenty-six (43%) patients developed parkinsonism (n = 17) or MCI (n = 9). Phenoconverters were older at iRBD diagnosis (p = 0.02). Median time to phenoconversion was 3.9 ± 2.5 years. iRBD phenoconverters had significantly more RSWA at diagnosis. Phenoconversion risk from iRBD diagnosis was 20% and 35% at 3 and 5 years, respectively, with greater risk in patients with iRBD with >46.4% any combined RSWA, which increased further to 30% and 55% at 3 and 5 years for patients >65 years of age at diagnosis. CONCLUSIONS Patients with iRBD with higher amounts of polysomnographic RSWA had a greater risk of developing Parkinson disease or MCI. Patients with older age and higher RSWA amounts had more rapid phenoconversion than younger patients with RBD. Our study suggests that RSWA is a potential biomarker for risk stratification of iRBD phenoconversion that could facilitate prognostication for patients with iRBD. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with iRBD, increased RSWA correlates with increased risk for developing parkinsonism or MCI.
Collapse
Affiliation(s)
- Stuart J McCarter
- From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - David J Sandness
- From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Allison R McCarter
- From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - John C Feemster
- From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Luke N Teigen
- From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Paul C Timm
- From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Bradley F Boeve
- From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Michael H Silber
- From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Erik K St Louis
- From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
| |
Collapse
|
28
|
Maltais DD, Miyagawa T, Min P, Przybelski SA, Jordan L, Lesnick TG, St. Louis E, Silber MH, Graff-Radford J, Jones DT, Savica R, Drubach DA, Knopman DS, Petersen RC, Fields JA, Machulda MM, Forsberg LK, Allen LA, Nedelska Z, Boeve BF, Kantarci K, Lowe VJ. P3-411: ANALYSIS OF IOFLUPANE-SPECT FINDINGS USING DATQUANT IN PATIENTS WITH IDIOPATHIC REM SLEEP BEHAVIOR DISORDER. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3445] [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: 10/25/2022]
Affiliation(s)
| | | | - Paul Min
- Mayo Clinic Rochester; Rochester MN USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
McCarter SJ, Boeve BF, Graff-Radford NR, Silber MH, St Louis EK. Neuroprotection in idiopathic REM sleep behavior disorder: a role for exercise? Sleep 2019; 42:5513724. [PMID: 31184756 DOI: 10.1093/sleep/zsz064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/14/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stuart J McCarter
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Bradley F Boeve
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael H Silber
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Erik K St Louis
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
30
|
|
31
|
Feemster JC, Jung J, Timm PC, Westerland SM, Gossard T, Teigen L, Cattaneo E, Imlach C, McCarter SJ, Smith KL, Boeve BF, Silber MH, St. Louis EK. 0650 Normative EMG Values and Isolated Rapid Eye Movement Sleep Without Atonia Frequency in Adults without REM Sleep Behavior Disorder. Sleep 2019. [DOI: 10.1093/sleep/zsz067.648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
|
32
|
Feinstein MA, Sharp RR, Sandness DJ, Feemster JC, Junna M, Kotagal S, Lipford MC, Tippmann-Peikert M, Boeve BF, Silber MH, St Louis EK. Physician and patient determinants of prognostic counseling in idiopathic REM sleep-behavior disorder. Sleep Med 2019; 62:80-85. [PMID: 31581066 DOI: 10.1016/j.sleep.2019.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/03/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES/BACKGROUND Prognostic counseling about the risk for developing overt neurodegenerative disorders for patients with idiopathic REM sleep-behavior disorder (iRBD) and isolated REM sleep without atonia (iRSWA) is difficult, given lack of disease-modifying interventions and uncertainty in accurate prognostication for individuals. We aimed to analyze patient and physician characteristics associated with documented prognostic discussions for patients with iRBD and iRSWA. PATIENTS/METHODS We retrospectively reviewed the medical records for 138 (112 iRBD and 26 iRSWA) patients seen at the Mayo Clinic between 2012 and 2015. We analyzed physician and patient demographics, initial complaint, and other information discussed during office visits. We then comparatively analyzed the impact of physician and patient characteristics on documented prognostic discussions using Chi Square or Fischer's exact test. RESULTS Mean iRBD patient age was 65.0 ± 13.0, and mean iRSWA age was 58 ± 15 years. Seventy-eight (69.6%) iRBD and 22 (84.6%) iRSWA patients were men. Sixty-two (55%) iRBD and three (12%) iRSWA patients received prognostic counseling about phenoconversion risk. iRBD was a secondary complaint in 67 (59.8%). Patients over age 60 years and those having iRBD as a chief complaint more frequently received prognostic discussions than those with opposite characteristics (all p < 0.05). Patient sex and antidepressant use were not associated with counseling. Sleep neurologists disclosed prognostic information most frequently, with male more likely than female clinicians to disclose prognoses. CONCLUSIONS Several patient and physician characteristics appear to influence documented prognostic counseling for iRBD/RSWA patients. Future studies of iRBD/RSWA patients' preferences are needed to clarify ethically appropriate physician-patient communication concerning prognosis.
Collapse
Affiliation(s)
- Max A Feinstein
- Mayo Center for Sleep Medicine, Department of Medicine, USA; Biomedical Ethics Research Program, USA; University of California San Francisco School of Medicine, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, USA; Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David J Sandness
- Mayo Center for Sleep Medicine, Department of Medicine, USA; Department of Neurology, USA
| | - John C Feemster
- Mayo Center for Sleep Medicine, Department of Medicine, USA; Department of Neurology, USA
| | - Mithri Junna
- Department of Neurology, USA; Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Suresh Kotagal
- Department of Neurology, USA; Mayo Clinic College of Medicine, Rochester, MN, USA; Department of Pediatrics and Adolescent Medicine, USA
| | - Melissa C Lipford
- Mayo Center for Sleep Medicine, Department of Medicine, USA; Department of Neurology, USA; Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Maja Tippmann-Peikert
- Mayo Center for Sleep Medicine, Department of Medicine, USA; Department of Neurology, USA; Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Department of Medicine, USA; Department of Neurology, USA; Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michael H Silber
- Mayo Center for Sleep Medicine, Department of Medicine, USA; Department of Neurology, USA; Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Department of Medicine, USA; Biomedical Ethics Research Program, USA; Department of Neurology, USA; Mayo Clinic College of Medicine, Rochester, MN, USA.
| |
Collapse
|
33
|
Kolla BP, Mansukhani MP, Olson EJ, St Louis EK, Silber MH, Morgenthaler TI. In Reply-Comment on Medical Cannabis for Obstructive Sleep Apnea: Premature and Potentially Harmful. Mayo Clin Proc 2018; 93:1689. [PMID: 30392554 DOI: 10.1016/j.mayocp.2018.08.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
|
34
|
Cohen AL, Mandrekar J, St Louis EK, Silber MH, Kotagal S. Response to "smoking, co-morbidities and narcolepsy". Sleep Med 2018; 52:237. [PMID: 30316702 DOI: 10.1016/j.sleep.2018.08.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alexander L Cohen
- Mayo Clinic, Department of Neurology, USA; Boston Children's Hospital, Department of Neurology, USA.
| | - Jay Mandrekar
- Mayo Clinic, Division of Biomedical Statistics and Informatics, USA
| | - Erik K St Louis
- Mayo Clinic, Department of Neurology, USA; Mayo Clinic, Center for Sleep Medicine, USA
| | - Michael H Silber
- Mayo Clinic, Department of Neurology, USA; Mayo Clinic, Center for Sleep Medicine, USA
| | - Suresh Kotagal
- Mayo Clinic, Department of Neurology, USA; Mayo Clinic, Division of Biomedical Statistics and Informatics, USA; Mayo Clinic, Center for Sleep Medicine, USA; Mayo Clinic, Department of Pediatric and Adolescent Medicine, USA
| |
Collapse
|
35
|
Cohen AL, Mandrekar J, St Louis EK, Silber MH, Kotagal S. Response to "High fatigue frequency in narcolepsy type 1 and type 2 in a Brazilian Sleep Center". Sleep Med 2018; 52:235. [PMID: 30293846 DOI: 10.1016/j.sleep.2018.08.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Alexander L Cohen
- Mayo Clinic, Department of Neurology, USA; Boston Children's Hospital, Department of Neurology, USA.
| | - Jay Mandrekar
- Mayo Clinic, Division of Biomedical Statistics and Informatics, USA
| | - Erik K St Louis
- Mayo Clinic, Department of Neurology, USA; Mayo Clinic, Center for Sleep Medicine, USA
| | - Michael H Silber
- Mayo Clinic, Department of Neurology, USA; Mayo Clinic, Center for Sleep Medicine, USA
| | - Suresh Kotagal
- Mayo Clinic, Department of Neurology, USA; Mayo Clinic, Division of Biomedical Statistics and Informatics, USA; Mayo Clinic, Center for Sleep Medicine, USA; Mayo Clinic, Department of Pediatric and Adolescent Medicine, USA
| |
Collapse
|
36
|
Silber MH, Becker PM, Buchfuhrer MJ, Earley CJ, Ondo WG, Walters AS, Winkelman JW. In Reply-Additional Safety Considerations Before Prescribing Opioids to Manage Restless Legs Syndrome. Mayo Clin Proc 2018; 93:955-956. [PMID: 29976378 DOI: 10.1016/j.mayocp.2018.03.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/26/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | | | - William G Ondo
- Methodist Research Institute and Weill Cornell Medical School, Houston, TX
| | | | - John W Winkelman
- Massachusetts General Hospital and Harvard University, Boston, MA
| |
Collapse
|
37
|
Abstract
PURPOSE OF REVIEW This article provides a clinical approach to the appropriate investigation and diagnosis of sleep disorders commonly seen by neurologists. RECENT FINDINGS Home sleep apnea testing in appropriate situations can replace laboratory polysomnography in many cases of uncomplicated sleep apnea. Multiple sleep latency tests must be performed meticulously and interpreted in the clinical setting to avoid overdiagnoses of narcolepsy. Human leukocyte antigen testing has limited utility in establishing a diagnosis of narcolepsy because a positive test has low specificity. Rapid eye movement (REM) sleep behavior disorder is frequently the first manifestation of an evolving synucleinopathy, and a careful history and neurologic examination are needed to determine other early features of these disorders. SUMMARY A meticulous history from the patient, supplemented by collateral history from an observer, is essential to establishing the diagnosis of sleep disorders. Judicious supplementary use of investigations, such as laboratory polysomnography, home sleep apnea testing, wrist actigraphy, and multiple sleep latency tests, can confirm the correct diagnosis. This article describes an approach to the sleepy patient, the patient with neuromuscular disease and possible sleep-disordered breathing, the patient with restless legs syndrome, and young and older patients with abnormal movements during sleep.
Collapse
|
38
|
Kolla BP, Mansukhani MP, Olson EJ, St Louis EK, Silber MH, Morgenthaler TI. Medical Cannabis for Obstructive Sleep Apnea: Premature and Potentially Harmful. Mayo Clin Proc 2018; 93:689-692. [PMID: 29866280 DOI: 10.1016/j.mayocp.2018.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Bhanu Prakash Kolla
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | - Meghna P Mansukhani
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic, Rochester, MN; Department of Family Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Eric J Olson
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Erik K St Louis
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Michael H Silber
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Timothy I Morgenthaler
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
39
|
McCarter SJ, Feemster JC, McCarter AR, Sandness DJ, Timm PC, Teigen LN, Boeve BF, Silber MH, St. Louis EK. 0660 Higher Amounts of REM Sleep without Atonia Predict Phenoconversion To Defined Neurodegenerative Disorders in Idiopathic REM Sleep Behavior Disorder. Sleep 2018. [DOI: 10.1093/sleep/zsy061.659] [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: 11/15/2022] Open
|
40
|
Abstract
STUDY OBJECTIVE To assess comorbidities in a community-based cohort of narcolepsy. METHODS A 2000-2014 community-based narcolepsy cohort was identified in Olmsted County, Minnesota. Records were reviewed by a certified sleep specialist for accuracy of diagnosis, and comorbidities were extracted and analyzed. Comorbidities in narcolepsy subjects, both at diagnosis and upon follow-up, were compared with those in unaffected and age- and sex-matched cohort using conditional logistic regression. RESULTS At diagnosis, there was increased association of narcolepsy with anxiety (OR 4.56, 95% CI 1.99-10.44), thyroid disease (3.07, 1.19-7.90), hypertension (2.69, 1.22-5.93), and hyperlipidemia (2.49, 1.05-5.92). At the end of the prolonged observation period of 9.9 years (SD 7.27 years), there was increased association of narcolepsy with peripheral neuropathy (11.21, 1.16-108.11), non-migrainous headache (6.00, 1.73-20.83), glucose intolerance (2.39, 1.05-5.45), and automobile-related trauma (2.43, 1.08-5.45). Persistently increased both at diagnosis and after a prolonged observation period were associations of narcolepsy with obstructive sleep apnea (OSA) (69.25, 9.26-517.99 decreasing to 13.55, 5.08-36.14), chronic low back pain (5.46, 2.46-12.11 to 2.58, 1.39-4.77), depression (4.88, 2.45-9.73 to 3.79, 2.12-6.79), psychiatric disorders in general (4.73, 2.49-9.01 to 3.40, 1.94-5.98), endocrinopathies (4.15, 1.81-9.56 to 2.45, 1.33-4.49), and obesity (2.27, 1.13-4.56 to 2.07, 1.15-3.7). CONCLUSIONS In this community-based study of narcolepsy comorbidities, both at diagnosis and after prolonged follow-up, persistent comorbidities were revealed, including OSA, chronic low back pain, psychiatric disorders in general, endocrinopathies, and obesity. The comprehensive management of narcolepsy requires monitoring for and managing these important associated health conditions.
Collapse
Affiliation(s)
- Alexander Cohen
- Mayo Clinic, Department of Neurology, USA; Boston Children's Hospital, Department of Neurology, USA.
| | - Jay Mandrekar
- Mayo Clinic, Division of Biomedical Statistics and Informatics, USA.
| | - Erik K St Louis
- Mayo Clinic, Department of Neurology, USA; Mayo Clinic, Center for Sleep Medicine, USA.
| | - Michael H Silber
- Mayo Clinic, Department of Neurology, USA; Mayo Clinic, Center for Sleep Medicine, USA.
| | - Suresh Kotagal
- Mayo Clinic, Department of Neurology, USA; Mayo Clinic, Division of Biomedical Statistics and Informatics, USA; Mayo Clinic, Center for Sleep Medicine, USA; Mayo Clinic, Department of Pediatric and Adolescent Medicine, USA.
| |
Collapse
|
41
|
Jung Y, Jordan LG, Lowe VJ, Kantarci K, Parisi JE, Dickson DW, Murray ME, Reichard RR, Ferman TJ, Jones DT, Graff-Radford J, Savica R, Machulda MM, Fields JA, Allen LA, Drubach DA, St Louis EK, Silber MH, Jack CR, Knopman DS, Petersen RC, Boeve BF. Clinicopathological and 123I-FP-CIT SPECT correlations in patients with dementia. Ann Clin Transl Neurol 2018; 5:376-381. [PMID: 29560382 PMCID: PMC5846445 DOI: 10.1002/acn3.521] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/03/2017] [Accepted: 12/06/2017] [Indexed: 01/29/2023] Open
Abstract
The relationship between clinicopathologic diagnosis and 123I‐FP‐CIT SPECT in 18 patients with dementia (12 with Lewy body disease) from one center in the United States was assessed. The sensitivity and specificity of abnormal 123I‐FP‐CIT SPECT with reduced striatal uptake on visual inspection for predicting Lewy body disease were 91.7% and 83.3%, respectively. The mean calculated putamen to occipital ratio (mPOR) based on regions of interest was significantly reduced in Lewy body disease compared to non‐Lewy body disease cases (P = 0.002). In this study, abnormal 123I‐FP‐CIT SPECT was strongly associated with underlying Lewy body disease pathology, supporting the utility of 123I‐FP‐CIT SPECT in the clinical diagnosis of dementia with Lewy bodies.
Collapse
Affiliation(s)
- Youngsin Jung
- Department of Neurology Mayo Clinic Rochester Minnesota
| | | | - Val J Lowe
- Department of Radiology Mayo Clinic Rochester Minnesota
| | | | - Joseph E Parisi
- Department of Neurology Mayo Clinic Rochester Minnesota.,Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota
| | | | | | - Ross R Reichard
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota
| | - Tanis J Ferman
- Department of Psychiatry and Psychology Mayo Clinic Jacksonville Florida
| | - David T Jones
- Department of Neurology Mayo Clinic Rochester Minnesota
| | | | | | - Mary M Machulda
- Department of Psychiatry and Psychology Mayo Clinic Rochester Minnesota
| | - Julie A Fields
- Department of Psychiatry and Psychology Mayo Clinic Rochester Minnesota
| | - Laura A Allen
- Department of Neurology Mayo Clinic Rochester Minnesota
| | | | - Erik K St Louis
- Department of Neurology Mayo Clinic Rochester Minnesota.,Center for Sleep Medicine Mayo Clinic Rochester Minnesota
| | - Michael H Silber
- Department of Neurology Mayo Clinic Rochester Minnesota.,Center for Sleep Medicine Mayo Clinic Rochester Minnesota
| | | | | | | | - Bradley F Boeve
- Department of Neurology Mayo Clinic Rochester Minnesota.,Center for Sleep Medicine Mayo Clinic Rochester Minnesota
| |
Collapse
|
42
|
Silber MH, Becker PM, Buchfuhrer MJ, Earley CJ, Ondo WG, Walters AS, Winkelman JW. The Appropriate Use of Opioids in the Treatment of Refractory Restless Legs Syndrome. Mayo Clin Proc 2018; 93:59-67. [PMID: 29304922 DOI: 10.1016/j.mayocp.2017.11.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/24/2017] [Accepted: 11/01/2017] [Indexed: 01/18/2023]
Abstract
Restless legs syndrome (RLS) is a distinct disorder, differing from chronic pain in many ways. Refractory RLS is characterized by unresponsiveness to dopamine agonists or alpha-2-delta ligands due to inadequate efficacy, augmentation, or adverse effects. This may result in severely impaired quality of life, profound insomnia, and suicidal depression. Opioid therapy is a mainstay in the management of these patients. This article summarizes the basic science and clinical evidence in support of their use, including the positive result of a large controlled multicenter study of 306 subjects, and outlines an approach to their use in clinical practice. Treatable explanations for RLS refractoriness, such as low iron stores, and other therapeutic options, such as combination therapy, should be considered before prescribing opioids. The agents most commonly used are oxycodone and methadone, but tramadol, codeine, morphine, and hydrocodone can also be considered. Controlled-release medication should be used for evening dosage and short-acting drugs, if needed, during the day. Effective doses are considerably lower than used for chronic pain (oxycodone 10-30 mg daily; methadone 5-20 mg daily) and the risk of opioid use disorder is relatively low. However, sensible precautions should be undertaken, including assessing opioid risk with standard questionnaires, using an opioid contract, using urine drug screens, consulting state prescription drug monitoring programs, and frequent reevaluation of effectiveness and side effects. Opioid use in selected patients with refractory RLS may be life-transforming with favorable risk-benefit ratio.
Collapse
Affiliation(s)
- Michael H Silber
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - Philip M Becker
- Sleep Medicine Associates of Texas and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mark J Buchfuhrer
- Department of Psychiatry and Behavioral Science, Stanford School of Medicine, Stanford, CA
| | - Christopher J Earley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William G Ondo
- Methodist Research Institute and Department of Neurology, Weill Cornell Medical School, Houston, TX
| | - Arthur S Walters
- Division of Sleep Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - John W Winkelman
- Department of Psychiatry and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | |
Collapse
|
43
|
Coon EA, Ahlskog JE, Silber MH, Fealey RD, Benarroch EE, Sandroni P, Mandrekar JN, Low PA, Singer W. Do selective serotonin reuptake inhibitors improve survival in multiple system atrophy? Parkinsonism Relat Disord 2017; 48:51-53. [PMID: 29254663 DOI: 10.1016/j.parkreldis.2017.12.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/14/2017] [Accepted: 12/11/2017] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Loss of brainstem serotonergic neurons in MSA patients is implicated in respiratory dysfunction including stridor and may increase the risk of sudden death. Augmenting serotonergic transmission through selective serotonergic reuptake inhibitors (SSRIs) has been proposed to improve stridor and prolong survival in multiple system atrophy (MSA). We sought to determine whether MSA patients on an SSRI during their disease course have improved survival compared to those not on an SSRI. METHODS Review of all MSA patients from 1998 to 2012 at Mayo Clinic, Rochester who completed autonomic function testing. Use of SSRI medications was obtained from patient-provided medication lists in the electronic medical record. Clinical symptoms were collected from patient histories; the presence of stridor was obtained from clinical histories and polysomnogram. Surviving patients were called to assess for stridor and SSRI use. RESULTS Of 685 MSA patients, 132 (19%) were on an SSRI. Median time from symptom onset to death was 7.5 years with no difference based on SSRI use (p = .957). Rates of stridor were similar in SSRI users and non-users based on patient report and polysomnography (p = .494 and p = .181, respectively). SSRI use was associated with parkinsonism (p = .027) and falls (p = .002). Stridor was similar in SSRI users and those not on an SSRI. CONCLUSIONS There was no difference in survival in MSA patients on an SSRI. However, SSRI use was associated with higher rates of parkinsonism and falls.
Collapse
Affiliation(s)
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Jay N Mandrekar
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
44
|
Boeve AR, Timm PC, McCord SV, Sandness DJ, McCarter SJ, Jung Y, Botha H, Fields JA, Ferman TJ, Silber MH, St. Louis EK, Boeve BF. [P1–483]: LONGITUDINAL PERFORMANCE ON THE KING DEVICK TEST IN PATIENTS WITH REM SLEEP BEHAVIOR DISORDER +/‐ MILD COGNITIVE IMPAIRMENT. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.499] [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: 10/18/2022]
|
45
|
Silber MH, Boeve BF, St Louis EK. Letter on "Natural history of pure autonomic failure: A United States prospective cohort". Ann Neurol 2017; 81:910. [PMID: 28472851 DOI: 10.1002/ana.24948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Michael H Silber
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Bradley F Boeve
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Erik K St Louis
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN
| |
Collapse
|
46
|
Jung Y, Boot BP, Mielke MM, Ferman TJ, Geda YE, McDade E, Christianson TJ, Knopman DS, St Louis EK, Silber MH, Petersen RC, Boeve BF. Phenoconversion from probable rapid eye movement sleep behavior disorder to mild cognitive impairment to dementia in a population-based sample. Alzheimers Dement (Amst) 2017. [PMID: 28649596 PMCID: PMC5470599 DOI: 10.1016/j.dadm.2017.05.004] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Rapid eye movement sleep behavior disorder (RBD) is strongly associated with synucleinopathies. In 2012, we reported an increased risk of mild cognitive impairment (MCI) and Parkinson disease (PD) in cognitively normal Olmsted County, Minnesota, residents, aged 70 to 89 years with probable RBD. Here, we examine their progression to dementia and other neurodegenerative phenotypes. Methods Fifteen participants with RBD who were diagnosed with either MCI or PD were longitudinally followed, and their subsequent clinical courses were reviewed. Results Over 6.4 ± 2.9 years, six of the 14 participants with MCI developed additional neurodegenerative signs, five of whom had Lewy body disease features. Four of them progressed to dementia at a mean age 84.8 ± 4.9 years, three of whom met the criteria for probable dementia with Lewy bodies. One subject with PD developed MCI, but not dementia. Discussion Our findings from the population-based sample of Olmsted County, Minnesota, residents suggest that a substantial number of RBD patients tend to develop overt synucleinopathy features over time, and RBD patients who develop MCI and subsequent dementia have clinical features most consistent with dementia with Lewy bodies.
Collapse
Affiliation(s)
- Youngsin Jung
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Brendon P. Boot
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Tanis J. Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Yonas E. Geda
- Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, AZ, USA
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Eric McDade
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | | | - Erik K. St Louis
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael H. Silber
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Bradley F. Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Corresponding author. Tel.: +1 507-538-1038; Fax: +1 507-538-6012.
| |
Collapse
|
47
|
Lipford MC, Williams J, Lorentz P, Collazo-Clavell M, Park JG, Olson EJ, St. Louis EK, Silber MH, Kellogg TA. 0745 RESTLESS LEGS SYNDROME / WILLIS EKBOM DISEASE IN BARIATRIC SURGERY PATIENTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.744] [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: 11/13/2022] Open
|
48
|
Jung Y, Silber MH, Tippmann-Peikert M, St Louis EK, Smith GE, Ferman TJ, Knopman DS, Petersen RC, Boeve BF. 1154 THE EFFECTS OF CPAP ON COGNITIVE AND FUNCTIONAL MEASURES IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT AND ALZHEIMER’S DEMENTIA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Boeve AR, McCord SV, Timm PC, Sandness DJ, Commers N, Duwell EJ, Tabatabai GM, McCarter SJ, Junna MR, Lipford MC, Tippmann-Peikert M, Boeve BF, Silber MH, St. Louis EK. 0722 NEURODEGENERATIVE BIOMARKER FREQUENCY IN IDIOPATHIC REM SLEEP BEHAVIOR DISORDER. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.721] [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
|
50
|
Tabatabai GM, Boeve AR, Commers N, McCarter SJ, McCord SV, Sandness DJ, Timm PC, Junna MR, Lipford MC, Maja T, Boeve BF, Silber MH, St. Louis EK. 0725 TIME COURSE FOR PHENOCONVERSION TO A DEFINED NEURODEGENERATIVE DISEASE IN WOMEN WITH IDIOPATHIC REM SLEEP BEHAVIOR DISORDER WITH AND WITHOUT ANTIDEPRESSANT USE. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|