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Nena E, Cassimos D, Kaditis A, Kourantzi M, Trakada G, Economou NT, Nikolaidis PT, Rosemann T, Knechtle B, Steiropoulos P, Tsalkidis A. Predictors of Sleep Duration and Sleep Disturbance in Children of a Culturally Diverse Region in North-Eastern Greece. Front Pediatr 2020; 8:23. [PMID: 32117830 PMCID: PMC7028695 DOI: 10.3389/fped.2020.00023] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Aim: The aim of this study was to examine the sleep characteristics of children and explore associations with various socio-demographic factors in an area of Greece characterized by cultural diversity. Methods: A questionnaire about children's sleep habits had been distributed to parents of children who visited the pediatric outpatient clinic of University General Hospital of Alexandroupolis for a medical examination and to get a health certificate for participation in sports activities. Children with chronic health conditions were excluded. Results: In the study, 449 children (27.1% belonging to minorities) were included, aged 7.6 ± 2.9 years. Most of them (81.7%) slept after 10 p.m., with a mean nocturnal sleep duration of 9.4 ± 1.2 h. The most commonly reported disturbance was snoring (26.2%). Age and high educational level of the mother were both important determinants for sleeping late [OR 1.139 (1.033-1.255); p = 0.009 and OR 1.086 (1.004-1.175); p = 0.040, respectively]. The latter was also associated with an absence of any reported sleep disorder in children [OR 0.934 (0.877-0.994); p = 0.031]. A longer sleep duration was reported among Roma children (p = 0.022), which was more overt in girls (mean sleep duration 10.4 ± 1.6 h). In the Roma group also, the prevalence of sleep disorders was higher. Conclusion: Age progression and maternal educational level, along with cultural background, seem to be correlated with variations in the sleep characteristics of children in a culturally diverse population in Greece.
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Affiliation(s)
- Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Cassimos
- Department of Paediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Kaditis
- Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine, Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Kourantzi
- Department of Paediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgia Trakada
- Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | - Nikolaos-Tiberio Economou
- Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | - Pantelis T Nikolaidis
- Exercise Physiology Laboratory, Nikaia, Greece.,School of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.,Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Paschalis Steiropoulos
- Sleep Laboratory, Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Angelos Tsalkidis
- Department of Paediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Kalligerou F, Ntanasi E, Voskou P, Velonakis G, Karavasilis E, Mamalaki E, Kyrozis A, Sigala E, Economou NT, Patas K, Yannakoulia M, Scarmeas N. Aiginition Longitudinal Biomarker Investigation Of Neurodegeneration (ALBION): study design, cohort description, and preliminary data. Postgrad Med 2019; 131:501-508. [PMID: 31483196 DOI: 10.1080/00325481.2019.1663708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/10/2023]
Abstract
Objectives: Aiginition Longitudinal Biomarker Investigation Of Neurodegeneration (ALBION) is a longitudinal ongoing study initiated in 2018 that takes place in the Cognitive Disorders Clinic of Aiginition Hospital of the National and Kapodistrian University of Athens. Its aim is to address several research questions concerning the preclinical and prodromal stage of Alzheimer's disease and explore potential markers for early detection, prediction, and primary prevention of dementia. Methods: We here present the design and the preliminary baseline characteristics of ALBION. The sample of our study consists of people aged over 50 who are concerned about their memory but are cognitively normal (CN) or have mild cognitive deficits. Each participant undergoes an extensive assessment including several demographic, medical, social, environmental, clinical, nutritional, neuropsychological determinants and lifestyle activities. Furthermore, we are collecting data from portable devices, neuroimaging techniques and biological samples (blood, stools, CSF). All participants are assessed annually for a period of 10 years. Results: In total, 47 participants have completed the initial evaluation up to date and are divided in two groups, CN individuals (N = 26) and MCI patients (N = 21), based on their cognitive status. The participants are, on average, 64 years old, 46.3% of the sample is male with an average of 12.73 years of education. MCI patients report more comorbidities and have a lower score in the MMSE test. Regarding APOE status, 2 participants are ε4 homozygotes and 10 ε4 heterozygotes. CSF analyses (Aβ42, Τ-tau, P-tau) revealed no differences between the two groups. Conclusion: The ALBION study offers an opportunity to explore preclinical dementia and identify new and tailored markers, particularly relating to lifestyle. Further investigation of these populations may provide a wider profile of the changes taking place in the preclinical phase of dementia, leading to potentially effective therapeutic and preventive strategies.
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Affiliation(s)
- F Kalligerou
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Ntanasi
- Department of Nutrition and Diatetics, Harokopio University , Athens , Greece
| | - P Voskou
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Velonakis
- 2nd department of Radliology, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Karavasilis
- 2nd department of Radliology, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Mamalaki
- Department of Nutrition and Diatetics, Harokopio University , Athens , Greece
| | - A Kyrozis
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Sigala
- Department of Nutrition and Diatetics, Harokopio University , Athens , Greece
| | - N T Economou
- Sleep Study Unit, Department of Psychiatry, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Patas
- Laboratory of Biopathology, Aiginition Hospital , Athens , Greece
| | - M Yannakoulia
- Department of Nutrition and Diatetics, Harokopio University , Athens , Greece
| | - N Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
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Zambelis T, Wolgamuth BR, Papoutsi SN, Economou NT. Restless legs syndrome mimicking S1 radiculopathy. Psychiatriki 2017; 27:222-226. [PMID: 27837576 DOI: 10.22365/jpsych.2016.273.222] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Α case of a chronic idiopathic form of a severe type of Restless Legs Syndrome (RLS), which developed during pregnancy and persisted after this, misdiagnosed for 34 years as radiculopathy S1, is reported. In spite of the thorough clinical and laboratory investigation, in addition to constant changes of the therapeutic approach, the diagnosis of S1 radiculopathy could not be confirmed, resulting in a chronic clinical course; the latter was characterized by relapses and remissions not attributed or linked in any way to the treatment (various types of). In fact, it was due to a routine workup in a sleep clinic, where the patient was referred because of a coincident chronic insomnia (Restless Legs Syndrome is a known and important cause of insomnia/chronic insomnia), which resulted in a proper diagnosis and treatment of this case. With the use of Restless Legs Syndrome appropriate treatment (Pramipexole 0.18 mg taken at bedtime, a dopaminergic agent and Level A recommended drug for Restless Legs Syndrome) an excellent response and immediate elimination of symptoms was achieved. Restless Legs Syndrome may present with a variety of symptoms (with the most prominent shortly being reported with the acronym URGE: Urge to move the legs usually associated with unpleasant leg sensations, Rest induces symptoms, Getting active brings relief, Evening and night deteriorate symptoms); given the fact that Restless Legs Syndrome presents with a great variety and heterogeneity of symptoms (mostly pain, dysesthesia and paresthesia), which may occur in several other diseases (the so called "RLS mimics"), proper diagnosis of Restless Legs Syndrome usually fails. Restless Legs Syndrome misinterpreted as S1 radiculopathy, to the best of our knowledge, has not been reported yet in the literature. Here, case history, clinical course and common RLS mimics are presented. Different forms of Restless Legs Syndrome manifestations, which are commonly -as in this case- misinterpreted due to their mimicking several pathological conditions, Restless Legs Syndrome prevalence on general population according to various large epidemiological studies and pathogenic hypotheses on the issue of Restless Legs Syndrome are discussed. Finally, by presenting another possible "RLS-mimic" our aim is to highlight the common misdiagnosis of Restless Legs Syndrome, which can mimic a variety of disorders, some of which are very common, such as an S1 radiculopathy, thus raising concern among doctors of various specialties addressed to by Restless Legs Syndrome sufferers, on the importance of proper diagnosis of the syndrome.
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Affiliation(s)
- Th Zambelis
- Department of Neurology, University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - B R Wolgamuth
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland, OH, USA
| | - S N Papoutsi
- Sleep Study Unit, Department of Psychiatry, University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - N T Economou
- Department of Neurology, University of Athens Medical School, Eginition Hospital, Athens, Greece.,Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland, OH, USA.,Sleep Study Unit, Department of Psychiatry, University of Athens Medical School, Eginition Hospital, Athens, Greece
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Tsiamis C, Economou NT, Poulakou-Rebelakou E. Theories and cures of the rheumatic diseases during the byzantine period (330-1453 a.D.). Reumatismo 2011; 58:157-64. [PMID: 16829994 DOI: 10.4081/reumatismo.2006.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Most Byzantine medical texts described the rheumatic diseases. The Byzantine physicians, based on the ancient Greek texts, explained the causes of rheumatic diseases, described their symptoms and proposed certain treatments. The Byzantine medical sources described various types of rheumatic diseases, as inflammatory arthritis, chronic deformans polyarthritis, and gout. As it can be concluded by the available medical sources, during the Byzantine period rheumatic diseases constituted a serious medical and social problem, representing a remarkable cause of disability, and this complaint was part of the epidemiological interest of the Byzantine physicians.
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Affiliation(s)
- C Tsiamis
- Cattedra di Storia della Medicina, Facoltà di Medicina, Università di Atene.
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Ktonas PY, Golemati S, Xanthopoulos P, Sakkalis V, Ortigueira MD, Tsekou H, Zervakis M, Paparrigopoulos T, Bonakis A, Economou NT, Theodoropoulos P, Papageorgiou SG, Vassilopoulos D, Soldatos CR. Time-frequency analysis methods to quantify the time-varying microstructure of sleep EEG spindles: possibility for dementia biomarkers? J Neurosci Methods 2009; 185:133-42. [PMID: 19747507 DOI: 10.1016/j.jneumeth.2009.09.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 07/31/2009] [Accepted: 09/02/2009] [Indexed: 11/15/2022]
Abstract
The time-varying microstructure of sleep EEG spindles may have clinical significance in dementia studies and can be quantified with a number of techniques. In this paper, real and simulated sleep spindles were regarded as AM/FM signals modeled by six parameters that define the instantaneous envelope (IE) and instantaneous frequency (IF) waveforms for a sleep spindle. These parameters were estimated using four different methods, namely the Hilbert transform (HT), complex demodulation (CD), matching pursuit (MP) and wavelet transform (WT). The average error in estimating these parameters was lowest for HT, higher but still less than 10% for CD and MP, and highest (greater than 10%) for WT. The signal distortion induced by the use of a given method was greatest in the case of HT and MP. These two techniques would necessitate the removal of about 0.4s from the spindle data, which is an important limitation for the case of spindles with duration less than 1s. Although the CD method may lead to a higher error than HT and MP, it requires a removal of only about 0.23s of data. An application of this sleep spindle parameterization via the CD method is proposed, in search of efficient EEG-based biomarkers in dementia. Preliminary results indicate that the proposed parameterization may be promising, since it can quantify specific differences in IE and IF characteristics between sleep spindles from dementia subjects and those from aged controls.
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Affiliation(s)
- P Y Ktonas
- Department of Psychiatry, University of Athens, Athens, Greece.
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Koutsourelakis I, Perraki E, Economou NT, Dimitrokalli P, Vagiakis E, Roussos C, Zakynthinos S. Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients. Eur Respir J 2009; 34:687-93. [PMID: 19357151 DOI: 10.1183/09031936.00124708] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Some patients with obstructive sleep apnoea syndrome (OSAS; respiratory distress index (RDI) of >5 events.h(-1)) experience residual excessive daytime subjective sleepiness (Epworth Sleepiness Scale (ESS) score of >10), despite adequate use of continuous positive airway pressure (CPAP) therapy. The aim of the present study was to identify clinical and polysomnographic predictors of this sleepiness. Clinical and polysomnographic variables and ESS score were evaluated in 208 OSAS patients with an ESS score of >10 before (initial assessment) and after > or =6 months of adequate (> or =4 h.day(-1)) CPAP use. Following CPAP treatment, 114 (55%) patients showed an abnormal ESS score (>10; CPAP nonresponders), whereas 94 (45%) showed a normal ESS score (<11; CPAP responders). Of the CPAP responders, none had a history of depression, whereas the converse was true for 38.8% of CPAP nonresponders. In addition, multivariate logistic regression analysis revealed that the independent predictors of residual excessive daytime sleepiness following CPAP therapy were a history of diabetes and heart disease, and a higher ESS score and lower RDI on initial assessment. In conclusion, predictors of residual excessive sleepiness in adequately CPAP-treated OSAS were a history of depression, diabetes and heart disease, and a higher ESS score and lower RDI on initial assessment.
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Affiliation(s)
- I Koutsourelakis
- Center of Sleep Disorders, Medical School of Athens University, Dept of Critical Care and Pulmonary Services, Evangelismos Hospital, Greece.
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Abstract
The aim of this study is to present epilepsy according to the most famous and representative Byzantine physicians throughout the whole period of the Byzantine empire. Mainly Byzantine medical texts were used as sources. The Byzantine physicians considered epilepsy to be a serious medical problem and followed the Hippocratic tradition as far as the etiology of this disease is concerned. Their pathophysiological theories of epilepsy identified the brain as the site of the problem, but, based on the Hippocratic humoral theory, emphasized causes such as an excess of humors or insufficient circulation of phlegm in the brain. It is surprising to note the accuracy of the details they provide regarding the clinical description of the disease, especially the seizures; many of these are still accepted today. It is also surprising that there was a concurrent opinion during all this medieval period that epilepsy was strictly an organic disease of the brain and the demonic origin of it a prejudice of uneducated people.
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Affiliation(s)
- N T Economou
- Department of the History of Medicine, Medical School, National Athens University, Athens, Greece.
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Abstract
OBJECTIVE To perform a large and detailed epidemiologic study on restless legs syndrome (RLS) during pregnancy and the puerperium. METHODS A structured clinical interview, assessing symptoms since the beginning of pregnancy, was performed to a population of 642 pregnant women at the time of delivery and at follow-up evaluation (1, 3, and 6 months after delivery). Main hematologic tests were also evaluated. A woman was considered affected if she met the International RLS Study Group criteria for RLS diagnosis. RESULTS Twenty-six percent of women were affected by RLS during their pregnancy. The disease was strongly related to the third trimester of pregnancy and tended to disappear reaching the time of delivery. Affected women presented lower values of hemoglobin and mean corpuscular volume compared with healthy subjects (both groups received the same supplemental iron and folate therapy). CONCLUSIONS Pregnancy is associated with transient restless legs syndrome.
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Affiliation(s)
- M Manconi
- Sleep Disorders Center, Department of Neurology, Vita-Salute University, IRCCS H.S. Raffaele, Milan, Italy.
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