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Quaedackers L, Van Gilst MM, Van Den Brandt I, Vilanova A, Lammers GJ, Markopoulos P, Overeem S. The Burden of Narcolepsy in Adults: A Population Sampling Study Using Personal Media. Behav Sleep Med 2024; 22:179-189. [PMID: 37246794 DOI: 10.1080/15402002.2023.2217971] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To obtain insight in the spectrum of narcolepsy symptoms and associated burden in a large cohort of patients. METHODS We used the Narcolepsy Monitor, a mobile app, to easily rate the presence and burden of 20 narcolepsy symptoms. Baseline measures were obtained and analyzed from 746 users aged between 18 and 75 years with a reported diagnosis of narcolepsy. RESULTS Median age was 33.0 years (IQR 25.0-43.0), median Ullanlinna Narcolepsy Scale 19 (IQR 14.0-26.0), 78% reported using narcolepsy pharmacotherapy. Excessive daytime sleepiness (97.2%) and lack of energy were most often present (95.0%) and most often caused a high burden (79.7% and 76.1% respectively). Cognitive symptoms (concentration 93.0%, memory 91.4%) and psychiatric symptoms (mood 76.8%, anxiety/panic 76.4%) were relatively often reported to be present and burdensome. Conversely, sleep paralysis and cataplexy were least often reported as highly bothersome. Females experienced a higher burden for anxiety/panic, memory, and lack of energy. CONCLUSIONS This study supports the notion of an elaborate narcolepsy symptom spectrum. Each symptom's contribution to the experienced burden varied, but lesser-known symptoms did significantly add to this as well. This emphasizes the need to not only focus treatment on the classical core symptoms of narcolepsy.
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Affiliation(s)
- L Quaedackers
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - M M Van Gilst
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - I Van Den Brandt
- Department of Mathematics and Computer Science, Algorithms and Visualization W&I, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - A Vilanova
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Mathematics and Computer Science, Algorithms and Visualization W&I, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Intelligence Systems, Electrical Engineering, Mathematics, and Computer Science, Delft University of Technology, Delft, The Netherlands
| | - G J Lammers
- Sleep-Wake Center SEIN, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - P Markopoulos
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S Overeem
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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2
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van den Broek N, van Meulen F, Ross M, Cerny A, Anderer P, van Gilst M, Pillen S, Overeem S, Fonseca P. Automated sleep staging in people with intellectual disabilities using heart rate and respiration variability. J Intellect Disabil Res 2023. [PMID: 37291951 DOI: 10.1111/jir.13060] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) have a higher risk of sleep disorders. Polysomnography (PSG) remains the diagnostic gold standard in sleep medicine. However, PSG in people with ID can be challenging, as sensors can be burdensome and have a negative influence on sleep. Alternative methods of assessing sleep have been proposed that could potentially transfer to less obtrusive monitoring devices. The goal of this study was to investigate whether analysis of heart rate variability and respiration variability is suitable for the automatic scoring of sleep stages in sleep-disordered people with ID. METHODS Manually scored sleep stages in PSGs of 73 people with ID (borderline to profound) were compared with the scoring of sleep stages by the CardioRespiratory Sleep Staging (CReSS) algorithm. CReSS uses cardiac and/or respiratory input to score the different sleep stages. Performance of the algorithm was analysed using input from electrocardiogram (ECG), respiratory effort and a combination of both. Agreement was determined by means of epoch-per-epoch Cohen's kappa coefficient. The influence of demographics, comorbidities and potential manual scoring difficulties (based on comments in the PSG report) was explored. RESULTS The use of CReSS with combination of both ECG and respiratory effort provided the best agreement in scoring sleep and wake when compared with manually scored PSG (PSG versus ECG = kappa 0.56, PSG versus respiratory effort = kappa 0.53 and PSG versus both = kappa 0.62). Presence of epilepsy or difficulties in manually scoring sleep stages negatively influenced agreement significantly, but nevertheless, performance remained acceptable. In people with ID without epilepsy, the average kappa approximated that of the general population with sleep disorders. CONCLUSIONS Using analysis of heart rate and respiration variability, sleep stages can be estimated in people with ID. This could in the future lead to less obtrusive measurements of sleep using, for example, wearables, more suitable to this population.
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Affiliation(s)
- N van den Broek
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
| | - F van Meulen
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - M Ross
- Sleep and Respiratory Care, Home Healthcare Solutions, Philips Austria GmbH, Vienna, Austria
| | - A Cerny
- Sleep and Respiratory Care, Home Healthcare Solutions, Philips Austria GmbH, Vienna, Austria
| | - P Anderer
- Sleep and Respiratory Care, Home Healthcare Solutions, Philips Austria GmbH, Vienna, Austria
| | - M van Gilst
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S Pillen
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
| | - S Overeem
- Centre for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - P Fonseca
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Eindhoven, The Netherlands
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Zhang Z, Dauvilliers Y, Plazzi G, Mayer G, Lammers G, Santamaria J, Gaig C, Partinen M, Overeem S, Rio-Villegas RD, Šonka K, Peraita-Adrados R, Heinzer R, Wierzbicka A, Högl B, Manconi M, Feketeova E, da Silva A, Bušková J, Bassetti C, Barateau L, Pizza F, Gool J, Fronczek R, Khatami R. Idling for decades: a European study on risk factors associated with long time to narcolepsy diagnosis. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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4
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Gool J, Zhang Z, Oei M, Mathias S, Dauvilliers Y, Mayer G, Plazzi G, del Rio-Villegas R, Santamaria J, Šonka K, Partinen M, Overeem S, Peraita-Adrados R, Heinzer R, Martins da Silva A, Högl B, Wierzbicka A, Heidbreder A, Feketeova E, Manconi M, Bušková J, Canellas F, Bassetti C, Barateau L, Pizza F, Schmidt M, Fronczek R, Khatami R, Lammers G. Unsupervised clustering of central hypersomnolence disorders enables data-driven phenotyping: toward more reliable diagnostic criteria. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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de Goederen R, Pu S, Silos Viu M, Doan D, Overeem S, Serdijn WA, Joosten KFM, Long X, Dudink J. Radar-based sleep stage classification in children undergoing polysomnography: a pilot-study. Sleep Med 2021; 82:1-8. [PMID: 33866298 DOI: 10.1016/j.sleep.2021.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVES Unobtrusive monitoring of sleep and sleep disorders in children presents challenges. We investigated the possibility of using Ultra-Wide band (UWB) radar to measure sleep in children. METHODS Thirty-two children scheduled to undergo a clinical polysomnography participated; their ages ranged from 2 months to 14 years. During the polysomnography, the children's body movements and breathing rate were measured by an UWB-radar. A total of 38 features were calculated from the motion signals and breathing rate obtained from the raw radar signals. Adaptive boosting was used as machine learning classifier to estimate sleep stages, with polysomnography as gold standard method for comparison. RESULTS Data of all participants combined, this study achieved a Cohen's Kappa coefficient of 0.67 and an overall accuracy of 89.8% for wake and sleep classification, a Kappa of 0.47 and an accuracy of 72.9% for wake, rapid-eye-movement (REM) sleep, and non-REM sleep classification, and a Kappa of 0.43 and an accuracy of 58.0% for wake, REM sleep, light sleep and deep sleep classification. CONCLUSION Although the current performance is not sufficient for clinical use yet, UWB radar is a promising method for non-contact sleep analysis in children.
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Affiliation(s)
- R de Goederen
- Pediatric Intensive Care Unit, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht Utrecht, the Netherlands
| | - S Pu
- Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands
| | - M Silos Viu
- Section Bioelectronics, Department of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - D Doan
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht Utrecht, the Netherlands
| | - S Overeem
- Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands; Sleep Medicine Center Kempenhaeghe, Heeze, the Netherlands
| | - W A Serdijn
- Section Bioelectronics, Department of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - K F M Joosten
- Pediatric Intensive Care Unit, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - X Long
- Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands
| | - J Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht Utrecht, the Netherlands.
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van der Sluiszen NNJJM, Urbanus B, Lammers GJ, Overeem S, Ramaekers JG, Vermeeren A. On-the-road driving performance of patients with central disorders of hypersomnolence. Traffic Inj Prev 2021; 22:120-126. [PMID: 33543997 DOI: 10.1080/15389588.2020.1862804] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 11/03/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Excessive Daytime Sleepiness is a core symptom of narcolepsy and idiopathic hypersomnia, which impairs driving performance. Adequate treatment improves daytime alertness, but it is unclear whether driving performance completely normalizes. This study compares driving performance of patients with narcolepsy and idiopathic hypersomnia receiving treatment to that of healthy controls. METHODS Patients diagnosed with narcolepsy type 1 (NT1, n = 33), narcolepsy type 2 (NT2, n = 7), or idiopathic hypersomnia (IH, n = 6) performed a standardized one-hour on-the-road driving test, measuring standard deviation of lateral position (SDLP). RESULTS Results showed that mean SDLP in patients did not differ significantly from controls, but the 95%CI of the mean difference (+1.02 cm) was wide (-0.72 to +2.76 cm). Analysis of subgroups, however, showed that mean SDLP in NT1 patients was significantly increased by 1.90 cm as compared to controls, indicating impairment. Moreover, four NT1 patients requested to stop the test prematurely due to self-reported somnolence, and two NT1 patients were stopped by the driving instructor for similar complaints. CONCLUSION Driving performance of NT1 patients may still be impaired, despite receiving treatment. No conclusions can be drawn for NT2 and IH patients due to the low sample sizes of these subgroups. In clinical practice, determination of fitness to drive for these patients should be based on an individual assessment in which also coping strategies are taken into account.
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Affiliation(s)
- N N J J M van der Sluiszen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - B Urbanus
- Stichting Epilepsie Instelling Nederland (SEIN), Heemstede, The Netherlands
| | - G J Lammers
- Stichting Epilepsie Instelling Nederland (SEIN), Heemstede, The Netherlands
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - S Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - A Vermeeren
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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van Gilst MM, Wulterkens BM, Fonseca P, Radha M, Ross M, Moreau A, Cerny A, Anderer P, Long X, van Dijk JP, Overeem S. Direct application of an ECG-based sleep staging algorithm on reflective photoplethysmography data decreases performance. BMC Res Notes 2020; 13:513. [PMID: 33168051 PMCID: PMC7653690 DOI: 10.1186/s13104-020-05355-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/23/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The maturation of neural network-based techniques in combination with the availability of large sleep datasets has increased the interest in alternative methods of sleep monitoring. For unobtrusive sleep staging, the most promising algorithms are based on heart rate variability computed from inter-beat intervals (IBIs) derived from ECG-data. The practical application of these algorithms is even more promising when alternative ways of obtaining IBIs, such as wrist-worn photoplethysmography (PPG) can be used. However, studies validating sleep staging algorithms directly on PPG-based data are limited. RESULTS We applied an automatic sleep staging algorithm trained and validated on ECG-data directly on inter-beat intervals derived from a wrist-worn PPG sensor, in 389 polysomnographic recordings of patients with a variety of sleep disorders. While the algorithm reached moderate agreement with gold standard polysomnography, the performance was significantly lower when applied on PPG- versus ECG-derived heart rate variability data (kappa 0.56 versus 0.60, p < 0.001; accuracy 73.0% versus 75.9% p < 0.001). These results show that direct application of an algorithm on a different source of data may negatively affect performance. Algorithms need to be validated using each data source and re-training should be considered whenever possible.
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Affiliation(s)
- M M van Gilst
- Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands. .,Sleep Medicine Centre Kempenhaeghe, Sterkselseweg 65, 5591 VE, Heeze, The Netherlands.
| | - B M Wulterkens
- Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.,Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, The Netherlands
| | - P Fonseca
- Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.,Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, The Netherlands
| | - M Radha
- Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.,Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, The Netherlands
| | - M Ross
- Sleep and Respiratory Care, Home Healthcare Solutions, Philips Austria GmbH, Kranichberggasse 4, 1120, Vienna, Austria
| | - A Moreau
- Sleep and Respiratory Care, Home Healthcare Solutions, Philips Austria GmbH, Kranichberggasse 4, 1120, Vienna, Austria
| | - A Cerny
- Sleep and Respiratory Care, Home Healthcare Solutions, Philips Austria GmbH, Kranichberggasse 4, 1120, Vienna, Austria
| | - P Anderer
- Sleep and Respiratory Care, Home Healthcare Solutions, Philips Austria GmbH, Kranichberggasse 4, 1120, Vienna, Austria
| | - X Long
- Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.,Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, The Netherlands
| | - J P van Dijk
- Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.,Sleep Medicine Centre Kempenhaeghe, Sterkselseweg 65, 5591 VE, Heeze, The Netherlands
| | - S Overeem
- Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.,Sleep Medicine Centre Kempenhaeghe, Sterkselseweg 65, 5591 VE, Heeze, The Netherlands
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Vinckenbosch F, Asin J, De Vries N, Vonk P, Donjacour C, Lammers G, Overeem S, Janssen H, Wang G, Chen D, Carter L, Zhou K, Vermeeren A, Ramaekers J. 0673 Effects Of Solriamfetol On Driving Performance In Participants With Excessive Daytime Sleepiness Associated With Obstructive Sleep Apnea. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.669] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA) is associated with an increased risk of driving accidents. Solriamfetol, a dopamine/norepinephrine reuptake inhibitor, is approved in the US (Sunosi®) for EDS associated with OSA (37.5-150 mg/day). This study evaluated solriamfetol’s effects on on-road driving performance in participants with EDS associated with OSA.
Methods
In each period of this randomized, double-blind, placebo-controlled, crossover study (NCT 02806895; EudraCT 2015-003930-28), driving performance during an on-road driving test was assessed at 2 hours and 6 hours postdose following 7 days of treatment with solriamfetol (150mg/day × 3, then 300mg/day × 4) or placebo. The primary endpoint—standard deviation of lateral position (SDLP), a measure of “weaving,” at 2 hours postdose—was compared between solriamfetol and placebo per time point using a repeated mixed-effects analysis of variance model.
Results
The study included 34 participants. Baseline characteristics reflected the broader OSA population (88% male; mean age=52 years; mean Epworth Sleepiness Scale score=14.4). SDLP at 2 hours postdose was statistically significantly lower following solriamfetol (least squares [LS] mean [standard error; SE], 18.83cm [0.63]) compared with placebo (19.92cm [0.63]): LS mean difference, -1.08cm; 95% confidence interval (CI), -1.85, -0.32; P=0.0062 (incomplete driving tests: solriamfetol, n=1; placebo, n=4), indicating better performance with solriamfetol. At 6 hours postdose, SDLP following solriamfetol (LS mean[SE], 19.24cm [0.63]) was statistically significantly lower compared with placebo (20.04cm [0.63]): LS mean difference, -0.80cm; 95% CI,
-1.58, -0.03; P=0.0432 (incomplete driving tests: solriamfetol, n=3; placebo, n=7). Common adverse events (≥5%) with solriamfetol were headache, nausea, insomnia, dizziness, and agitation.
Conclusion
Solriamfetol (300mg/day) improved SDLP, an important measure of driving performance, at 2 and 6 hours in participants with EDS associated with OSA.
Support
Jazz Pharmaceuticals
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Affiliation(s)
| | - J Asin
- Amphia Ziekenhuis, Breda, NETHERLANDS
| | - N De Vries
- Onze Lieve Vrouwe Gasthuis, Amsterdam, NETHERLANDS
| | - P Vonk
- Onze Lieve Vrouwe Gasthuis, Amsterdam, NETHERLANDS
| | | | - G Lammers
- Sleep-Wake Centre SEIN, Zwolle, NETHERLANDS
| | | | | | - G Wang
- Jazz Pharmaceuticals, Palo Alto, CA
| | - D Chen
- Jazz Pharmaceuticals, Palo Alto, CA
| | - L Carter
- Jazz Pharmaceuticals, Palo Alto, CA
| | - K Zhou
- Jazz Pharmaceuticals, Palo Alto, CA
| | - A Vermeeren
- Maastricht University, Maastricht, NETHERLANDS
| | - J Ramaekers
- Maastricht University, Maastricht, NETHERLANDS
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Hermans L, van Gilst M, Langen H, van Mierlo P, Leufkens T, Overeem S. The influence of the length of awakenings on sleep onset misperception. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Abstract
Objective: This study aimed to establish the determinants of perceived sleep quality over a longer period of time, taking into account the separate contributions of actigraphy-based sleep measures and self-reported sleep indices. Methods: Fifty participants (52 ± 6.6 years; 27 females) completed two consecutive weeks of home monitoring, during which they kept a sleep-wake diary while their sleep was monitored using a wrist-worn actigraph. The diary included questions on perceived sleep quality, sleep-wake information, and additional factors such as well-being and stress. The data were analyzed using multilevel models to compare a model that included only actigraphy-based sleep measures (model Acti) to a model that included only self-reported sleep measures to explain perceived sleep quality (model Self). In addition, a model based on the self-reported sleep measures and extended with nonsleep-related factors was analyzed to find the most significant determinants of perceived sleep quality (model Extended). Results: Self-reported sleep measures (model Self) explained 61% of the total variance, while actigraphy-based sleep measures (model Acti) only accounted for 41% of the perceived sleep quality. The main predictors in the self-reported model were number of awakenings during the night, sleep onset latency, and wake time after sleep onset. In the extended model, the number of awakenings during the night and total sleep time of the previous night were the strongest determinants of perceived sleep quality, with 64% of the variance explained. Conclusion: In our cohort, perceived sleep quality was mainly determined by self-reported sleep measures and less by actigraphy-based sleep indices. These data further stress the importance of taking multiple nights into account when trying to understand perceived sleep quality.
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Affiliation(s)
- M S Goelema
- a Personal Health Group , Philips Group Innovation Research , Eindhoven , The Netherlands.,b Department of Industrial Design , Eindhoven University of Technology , Eindhoven , The Netherlands
| | - M Regis
- a Personal Health Group , Philips Group Innovation Research , Eindhoven , The Netherlands.,c Department of Mathematics and Computer Science , Eindhoven University of Technology , Eindhoven , The Netherlands
| | - R Haakma
- a Personal Health Group , Philips Group Innovation Research , Eindhoven , The Netherlands
| | - E R van den Heuvel
- c Department of Mathematics and Computer Science , Eindhoven University of Technology , Eindhoven , The Netherlands
| | - P Markopoulos
- b Department of Industrial Design , Eindhoven University of Technology , Eindhoven , The Netherlands
| | - S Overeem
- b Department of Industrial Design , Eindhoven University of Technology , Eindhoven , The Netherlands.,d Sleep Medicine Center, Kempenhaeghe , Heeze , The Netherlands
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12
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de Vries NM, Smilowska K, Hummelink J, Abramiuc B, van Gilst MM, Bloem BR, de With PHN, Overeem S. Exploring the Parkinson patients' perspective on home-based video recording for movement analysis: a qualitative study. BMC Neurol 2019; 19:71. [PMID: 31029123 PMCID: PMC6486968 DOI: 10.1186/s12883-019-1301-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 04/11/2019] [Indexed: 12/16/2022] Open
Abstract
Background Parkinson’s disease is a complex neurological disorder characterized by a variety of motor- as well as non-motor symptoms. Video-based technology (using continuous home monitoring) may bridge the gap between the fragmented in-clinic observations and the need for a comprehensive understanding of the progression and fluctuation of disease symptoms. However, continuous monitoring can be intrusive, raising questions about feasibility as well as potential privacy violation. Methods We used a grounded theory approach in which we performed semi-structured interviews to explore the opinion of Parkinson’s patients on home-based video recording used for vision-based movement analysis. Results Saturation was reached after sixteen interviews. Three first–level themes were identified that specify the conditions required to perform continuous video monitoring: Camera recording (e.g. being able to turn off the camera), privacy protection (e.g. patient’s behaviour, patient’s consent, camera location) and perceived motivation (e.g. contributing to science or clinical practice). Conclusion Our findings show that Parkinson patients’ perception of continuous, home-based video recording is positive, when a number of requirements are taken into account. This knowledge will enable us to start using this technology in future research and clinical practice in order to better understand the disease and to objectify outcomes in the patients’ own homes.
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Affiliation(s)
- N M de Vries
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - K Smilowska
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - J Hummelink
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - B Abramiuc
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands
| | - M M van Gilst
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands.,Eindhoven University of Technology, Sleep Medicine Centre Kempenhaeghe, Heeze, the Netherlands
| | - B R Bloem
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - P H N de With
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands
| | - S Overeem
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands.,Eindhoven University of Technology, Sleep Medicine Centre Kempenhaeghe, Heeze, the Netherlands
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Pizza F, Antelmi E, Vandi S, Meletti S, Erro R, Baumann C, Bhatia K, Dauvilliers Y, Edwards M, Iranzo A, Overeem S, Tinazzi M, Liguori R, Plazzi G. The distinguishing motor features of cataplexy: a study from video recorded attacks. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pillen S, Vandenbussche NLE, Fronczek R, van Duijn J, Lammers GJ, Overeem S. [Kleine Levin Syndrome: more than just periodic hypersomnia]. Ned Tijdschr Geneeskd 2016; 160:D238. [PMID: 27484420] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Kleine Levin Syndrome (KLS) is a rare disease with periodic hypersomnia as its main feature. Hyperphagia and hypersexuality are also described as classical symptoms, although quite recently it has become clear that the full triad is absent in the majority of patients. CASE DESCRIPTION A 14-year-old boy developed KLS after a period of flu-like symptoms. Over the course of three years he suffered from seven one-week episodes of extreme hypersomnia (sleeping 18 hours a day), depersonalisation, apathy, anxiety, paranoia, confusion, hallucinations and uninhibited sexual behaviour. He ate little. Ancillary investigations did not reveal any abnormalities. In between these episodes he had no symptoms. CONCLUSION From this case description and a summary of the symptoms of twelve other patients with KLS, it appears that neuropsychiatric symptoms are much more prominent than hyperphagia and hypersexuality. It is important that the typical KLS phenotype be reappraised, so that the condition can be recognised early and patients managed appropriately.
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Affiliation(s)
- S Pillen
- Centrum voor Slaapgeneeskunde, Kempenhaeghe, Heeze
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15
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Stummer C, Dibilio V, Overeem S, Weerdesteyn V, Bloem B, Nonnekes J. The walk-bicycle: a new assistive device for patients with Parkinson's disease and freezing of gait? Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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van der Kolk N, van Nimwegen M, Speelman A, Munneke M, Backx F, Donders R, Post B, Overeem S, Bloem B. A personalized coaching program increases outdoor activities and physical fitness in sedentary Parkinson patients; a post-hoc analysis of the ParkFit trial. Parkinsonism Relat Disord 2014; 20:1442-4. [DOI: 10.1016/j.parkreldis.2014.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/25/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
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Donjacour C, Schoffelen P, Overeem S, Lammers G, Pijl H, Westerterp K. Energy expenditure in narcolepsy patients and controls. Sleep Med 2013. [DOI: 10.1016/j.sleep.2013.11.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Schie MV, Werth E, Lammers G, Overeem S, Baumann C, Fronczek R. The effects of sodium oxybate treatment on vigilance impairment in narcolepsy – A comparison between in-field and in-laboratory measurements. Sleep Med 2013. [DOI: 10.1016/j.sleep.2013.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Louter M, van der Marck MA, Pevernagie DAA, Munneke M, Bloem BR, Overeem S. Sleep matters in Parkinson's disease: use of a priority list to assess the presence of sleep disturbances. Eur J Neurol 2012; 20:259-65. [PMID: 22900781 DOI: 10.1111/j.1468-1331.2012.03836.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 07/04/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Despite their high prevalence and clinical impact, sleep disorders in Parkinson's disease appear to receive insufficient attention in clinical practice. We compared the importance of sleep disorders relative to other symptoms and daily issues. Furthermore, we determined whether relevance as perceived by patients correlated with the subjective presence of sleep disruption scored with a rating scale. METHODS We studied a cohort of 153 consecutive patients (95 men) who were referred for problems other than sleep to our referral center. Prior to their visit, patients ranked their individual top five clinical priorities (of 23 items), indicating the most problematic domains for which they requested medical attention. Additionally, nocturnal sleep quality and excessive daytime sleepiness (EDS) were assessed with validated questionnaires. RESULTS The top three important domains according to the patient were movement (79.9%), medication (73.2%), and physical condition (63.4%). Sleep was the sixth most frequently reported item, marked by 37.9% of the patients. Amongst the patients who scored sleep as a priority, 47 (81%) had a poor sleep quality (Pittsburgh Sleep Quality Index > 5). Although EDS was present in almost 30% of patients, a minority of them put it on their priority list. CONCLUSION A priority list can be used to prioritize patient-centered quality of life issues. Our results show that sleep is a clinical priority for about one-third of patients. Surprisingly, EDS was usually not prioritized by patients during the consultation, underscoring the need to use ratings scales alongside subjective priorities.
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Affiliation(s)
- M Louter
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Nanhoe-Mahabier W, Allum JH, Pasman EP, Overeem S, Bloem BR. The effects of vibrotactile biofeedback training on trunk sway in Parkinson's disease patients. Parkinsonism Relat Disord 2012; 18:1017-21. [PMID: 22721975 DOI: 10.1016/j.parkreldis.2012.05.018] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 04/14/2012] [Accepted: 05/18/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postural instability in Parkinson's disease (PD) can lead to falls, injuries and reduced quality of life. We investigated whether balance in PD can improve by offering patients feedback about their own trunk sway as a supplement to natural sensory inputs. Specifically, we investigated the effect of artificial vibrotactile biofeedback on trunk sway in PD. METHODS Twenty PD patients were assigned to a control group (n = 10) or biofeedback group (n = 10). First, all patients performed two sets of six gait tasks and six stance tasks (pre-training assessment). Subsequently, all subjects trained six selected tasks five times (balance training). During this training, the feedback group received vibrotactile feedback of trunk sway, via vibrations delivered at the head. After training, both groups repeated all twelve tasks (post-training assessment). During all tasks, trunk pitch and roll movements were measured with angular velocity sensors attached to the lower trunk. Outcomes included sway angle and sway angular velocity in the roll and pitch plane, and task duration. RESULTS Overall, patients in the feedback group had a significantly greater reduction in roll (P = 0.005) and pitch (P < 0.001) sway angular velocity. Moreover, roll sway angle increased more in controls after training, suggesting better training effects in the feedback group (P < 0.001). CONCLUSIONS One session of balance training in PD using a biofeedback system showed beneficial effects on trunk stability. Additional research should examine if these effects increase further after more intensive training, how long these persist after training has stopped, and if the observed effects carry over to non-trained tasks.
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Affiliation(s)
- W Nanhoe-Mahabier
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Nanhoe-Mahabier W, Allum JHJ, Overeem S, Borm GF, Oude Nijhuis LB, Bloem BR. First trial reactions and habituation rates over successive balance perturbations in Parkinson's disease. Neuroscience 2012; 217:123-9. [PMID: 22542872 DOI: 10.1016/j.neuroscience.2012.03.064] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/18/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Balance control in Parkinson's disease is often studied using dynamic posturography, typically with serial identical balance perturbations. Because subjects can learn from the first trial, the magnitude of balance reactions rapidly habituates during subsequent trials. Changes in this habituation rate might yield a clinically useful marker. We studied balance reactions in Parkinson's disease using posturography, specifically focusing on the responses to the first, fully unpractised balance disturbance, and on the subsequent habituation rates. METHODS Eight Parkinson patients and eight age- and gender-matched controls received eight consecutive toe-up rotations of a support-surface. Balance reactions were measured with a motion analysis system and converted to centre of mass displacements (primary outcome). RESULTS Mean centre of mass displacement during the first trial was 51% greater in patients than controls (P=0.019), due to excessive trunk flexion and greater ankle plantar-flexion. However, habituated trials were comparable in both groups. Patients also habituated slower: controls were fully habituated at trial 2, whereas habituation in patients required up to five trials (P=0.004). The number of near-falls during the first trial was significantly correlated with centre of mass displacement during the first trial and with habituation rate. CONCLUSIONS Higher first trial reactions and a slow habituation rate discriminated Parkinson's patients from controls, but habituated trials did not. Further work should demonstrate whether this also applies to clinical balance tests, such as the pull test, and whether repeated delivery of such tests offers better diagnostic value for evaluating fall risks in parkinsonian patients.
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Affiliation(s)
- W Nanhoe-Mahabier
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Droogleever Fortuyn H, Mulders P, Renier W, Buitelaar J, Overeem S. Narcolepsy and psychiatry: An evolving association of increasing interest. Sleep Med 2011; 12:714-9. [PMID: 21689985 DOI: 10.1016/j.sleep.2011.01.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 12/13/2010] [Accepted: 01/05/2011] [Indexed: 11/26/2022]
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Nanhoe-Mahabier W, Snijders AH, Delval A, Weerdesteyn V, Duysens J, Overeem S, Bloem BR. Walking patterns in Parkinson's disease with and without freezing of gait. Neuroscience 2011; 182:217-24. [PMID: 21382449 DOI: 10.1016/j.neuroscience.2011.02.061] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/01/2011] [Accepted: 02/28/2011] [Indexed: 11/28/2022]
Abstract
The pathophysiology underlying freezing of gait (FOG) in Parkinson's disease remains incompletely understood. Patients with FOG ("freezers") have a higher temporal variability and asymmetry of strides compared to patients without FOG ("non-freezers"). We aimed to extend this view, by assessing spatial variability and asymmetry of steps and interlimb coordination between the upper and lower limbs during gait. Twelve freezers, 15 non-freezers, and 15 age-matched controls were instructed to walk overground and on a treadmill. Kinematic data were recorded with a motion analysis system. Both freezers and non-freezers showed an increased spatial variability of leg movements compared to controls. In addition, both patient groups had a deficit in interlimb coordination, not only between ipsilateral arms and legs, but also between diagonally positioned limbs. The only difference between freezers and non-freezers was a decreased step length during treadmill walking. We conclude that parkinsonian gait-regardless of FOG-is irregular, not only in the legs, but also with respect to interlimb coordination between the arms and legs. FOG is reflected by abnormal treadmill walking, presumably because this provides a greater challenge to the defective supraspinal control than overground walking, hampering the ability of freezers to increase their stride length when necessary.
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Affiliation(s)
- W Nanhoe-Mahabier
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Speelman A, van Nimwegen M, Smulders K, Overeem S, Borm G, Backx F, Bloem B, Munneke M. 201 RATIONALE AND DESIGN OF THE PARKFIT STUDY: A RANDOMIZED CONTROLLED TRIAL TO INCREASE PHYSICAL ACTIVITY IN PATIENTS WITH PARKINSON'S DISEASE. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Snijders A, Leunissen H, Bakker M, Overeem S, Helmich R, van Oosten R, Toni I, Bloem B. 025 THE MESENCEPHALIC LOCOMOTOR REGION IN PATIENTS WITH FREEZING OF GAIT AND PARKINSON'S DISEASE: A MOTOR IMAGERY STUDY. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Nijkrake MJ, Keus SHJ, Quist-Anholts GWL, Overeem S, De Roode MH, Lindeboom R, Mulleners W, Bloem BR, Munneke M. Evaluation of a Patient-Specific Index as an outcome measure for physiotherapy in Parkinson's disease. Eur J Phys Rehabil Med 2009; 45:507-512. [PMID: 20032909] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The aim of this paper was to develop and evaluate a patient-specific index for physiotherapy in Parkinson's disease (PSI-PD). METHODS In the PSI-PD, patients 1) select problematic activities out of a predefined list, with one self-report item; 2) rank selected items in order of importance; and 3) rate severity for each ranked item. To examine test-retest reliability, a cohort of patients was asked to complete the PSI-PD twice. Afterwards, validity was evaluated using a telephone interview. RESULTS The PSI-PD was completed twice by 81 patients. Test-retest agreement for the selection of activity limitations was 73% to 94%. Items ranked by patients were categorized into domains, of which gait, transfers and dexterity were rated most frequently (41%-70%). Test-retest agreement for ranked domains ranged from 74% to 82%. Interviews confirmed that the PSI-PD reliably identified problem areas. CONCLUSIONS The PSI-PD is a relevant, reliable and valid instrument to identify limitations in everyday activities that are important for both PD patients and physiotherapists.
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Affiliation(s)
- M J Nijkrake
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Tieleman A, Knoop H, van de Logt A, Bleijenberg G, van Engelen B, Overeem S. G.P.14.06 Sleep disturbances in myotonic dystrophy type 2: A comparison with myotonic dystrophy type 1 and healthy controls. Neuromuscul Disord 2009. [DOI: 10.1016/j.nmd.2009.06.313] [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: 11/25/2022]
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29
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Nijkrake MJ, Keus SHJ, Ewalds H, Overeem S, Braspenning JCC, Oostendorp RAB, Hendriks EJM, Bloem BR, Munneke M. Quality indicators for physiotherapy in Parkinson's disease. Eur J Phys Rehabil Med 2009; 45:239-245. [PMID: 19377415] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM The aim of this study was to develop quality indicators for physiotherapy in Parkinson's disease (PD) according to international criteria. METHODS Indicators were based on an evidence-based guideline for physiotherapy in PD. Guideline recommendations were transformed into indicators and rated for their relevance by an expert panel. Relevant indicators were incorporated into a questionnaire termed ''Quality Indicators for Physiotherapy in PD'' (QIP-PD). The QIP-PD was piloted among 105 physiotherapists. The adjusted version was evaluated in 46 physiotherapists with specific expertise in PD and in 795 general physiotherapists. The following clinimetric aspects of the QIP-PD were tested: completeness of answers, response distribution, internal consistency, and discriminative power. The reliability of the QIP-PD was evaluated by interviews among a randomly selected cohort of 32 PD experts and 32 general physiotherapists. RESULTS The expert panel selected 16 indicators, which were transformed into an adjusted 17-item QIP-PD. The adjusted QIP-PD was completed by 41 expert physiotherapists and 286 general physiotherapists. Comple-teness of item scores ranged from 95-98%. Six items were excluded from the final analyses as they showed ceiling effect among both groups, or lacked discriminative power. The total QIP-PD score for the 11 items was significantly higher for expert physiotherapists (35.1+/-4.2) compared to general physiotherapists (22.2+/-7.7; P=0.01). Internal consistency was good (Crohnbach's alpha 0.84). QIP-PD scores of therapists and interviewers (correlated using Intraclass Correlations Coefficients) ranged from 0.63 to 0.75. CONCLUSIONS The QIP-PD is a relevant, feasible, valid, discriminative and reliable instrument to measure adherence to guidelines for physiotherapy in PD. In addition, the results underscore that quality improvement interventions for physiotherapy in PD are needed, as guideline adherence is suboptimal in physiotherapists without specific PD expertise.
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Affiliation(s)
- M J Nijkrake
- Donders Center for Brain, Cognition and Behavior, Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Fronczek R, Raymann RJEM, Overeem S, Romeijn N, van Dijk JG, Lammers GJ, Van Someren EJW. Manipulation of skin temperature improves nocturnal sleep in narcolepsy. J Neurol Neurosurg Psychiatry 2008; 79:1354-7. [PMID: 18653548 DOI: 10.1136/jnnp.2008.143610] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Besides excessive daytime sleepiness, disturbed nocturnal sleep is a major complaint of patients with narcolepsy. Previously, alterations in skin temperature regulation in narcoleptic patients have been shown to be related to increased sleepiness. This study tests the hypothesis that direct control of nocturnal skin temperature might be applied to improve the disturbed sleep of narcoleptic patients. METHODS Participants were eight patients (five males) diagnosed as having narcolepsy with cataplexy according to the ICSD-2 criteria, mean (SD) age 28.6 (6.4) years, range 18-35 years. During two nights, sleep was recorded polysomnographically while proximal and distal skin temperature were manipulated using a comfortable thermosuit that induced skin temperature to cycle slowly with an amplitude of only 0.4 degrees C within the comfortable range normally observed during sleep. Logistic regression was used to evaluate the effect of skin temperature manipulation on the probability of occurrence of different sleep stages and nocturnal wakefulness. RESULTS Proximal skin warming significantly suppressed wakefulness and enhanced slow wave sleep (SWS). In contrast, distal skin warming enhanced wakefulness and stage 1 sleep at the cost of SWS and REM sleep. The optimal combination of proximal skin warming and distal skin cooling led to a 160% increase in SWS, a 50% increase in REM sleep and a 68% decrease in wakefulness, compared with the least beneficial combination of proximal skin cooling and distal skin warming. INTERPRETATION Subtle skin temperature manipulations under controlled conditions significantly improved the typical nocturnal sleep problems in narcolepsy.
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Affiliation(s)
- R Fronczek
- Leiden University Medical Centre, Department of Neurology (K5Q), PO Box 9600, 2300 RC, Leiden, The Netherlands.
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Bakker M, Overeem S, Snijders AH, Borm G, van Elswijk G, Toni I, Bloem BR. Motor imagery of foot dorsiflexion and gait: Effects on corticospinal excitability. Clin Neurophysiol 2008; 119:2519-27. [PMID: 18838294 DOI: 10.1016/j.clinph.2008.07.282] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 06/09/2008] [Accepted: 07/12/2008] [Indexed: 11/29/2022]
Affiliation(s)
- M Bakker
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, The Netherlands
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Abdo W, Bloem B, Kremer H, Lammers G, Verbeek M, Overeem S. CSF hypocretin-1 levels are normal in multiple-system atrophy. Parkinsonism Relat Disord 2008; 14:342-4. [DOI: 10.1016/j.parkreldis.2007.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 08/14/2007] [Accepted: 08/24/2007] [Indexed: 12/31/2022]
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Bakker M, Overeem S, Snijders A, van Elswijk G, Toni I, Bloem B. P1.033 Motor imagery of foot dorsiflexion and gait: effects on cortico-spinal excitability. Parkinsonism Relat Disord 2008. [DOI: 10.1016/s1353-8020(08)70130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oude Nijhuis L, Allum J, Overeem S, Bloem B. P1.097 The nature of the “first trial reaction” in balance control. Parkinsonism Relat Disord 2008. [DOI: 10.1016/s1353-8020(08)70194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nijhuis LO, Janssen L, Bloem B, van Dijk J, Gielen S, Borm G, Overeem S. P27. Choice reaction times for human head rotations are shortened by startling acoustic stimuli, irrespective of stimulus direction. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2007.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Overeem S, Afink J, Bakker M, Lammers GJ, Zwarts M, Bloem BR, van Dijk JG. High frequency repetitive transcranial magnetic stimulation over the motor cortex: No diagnostic value for narcolepsy/cataplexy. J Neurol 2007; 254:1459-61. [PMID: 17579803 PMCID: PMC2778683 DOI: 10.1007/s00415-007-0562-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 12/19/2006] [Accepted: 01/03/2007] [Indexed: 12/03/2022]
Affiliation(s)
- S. Overeem
- Dept. of Neurology, Radboud University Nijmegen Medical Centre, 9101, 6500 HB Nijmegen, The Netherlands
- Dept. of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J. Afink
- Dept. of Neurology, Radboud University Nijmegen Medical Centre, 9101, 6500 HB Nijmegen, The Netherlands
| | - M. Bakker
- Dept. of Neurology, Radboud University Nijmegen Medical Centre, 9101, 6500 HB Nijmegen, The Netherlands
| | - G. J. Lammers
- Dept. of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M. Zwarts
- Dept. of Neurology, Radboud University Nijmegen Medical Centre, 9101, 6500 HB Nijmegen, The Netherlands
| | - B. R. Bloem
- Dept. of Neurology, Radboud University Nijmegen Medical Centre, 9101, 6500 HB Nijmegen, The Netherlands
| | - J. G. van Dijk
- Dept. of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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Fronczek R, van der Zande WLM, van Dijk JG, Overeem S, Lammers GJ. [Narcolepsy: a new perspective on diagnosis and treatment]. Ned Tijdschr Geneeskd 2007; 151:856-61. [PMID: 17472116] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The 5 classic symptoms of narcolepsy are excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disturbed nocturnal sleep. The presence of cataplexy is strongly associated with a deficiency of the neuropeptide hypocretin. This discovery has led to new diagnostic subclassifications: narcolepsy without cataplexy, which can be demonstrated by a multiple sleep latency test, and narcolepsy with cataplexy, which can be confirmed with a multiple sleep latency test or a cerebrospinal fluid deficiency of hypocretin I. Various treatment options are available, including psychostimulants and gamma hydroxybuterate.
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Affiliation(s)
- R Fronczek
- Leids Universitair Medisch Centrum, afd. Neurologie en Klinische Neurofysiologie, Postbus 9600, 2300 RC Leiden
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Overeem S, Schelhaas HJ, Blijham PJ, Grootscholten MI, ter Laak HJ, Timmermans J, van den Wijngaard A, Zwarts MJ. Symptomatic distal myopathy with cardiomyopathy due to a MYH7 mutation. Neuromuscul Disord 2007; 17:490-3. [PMID: 17383184 DOI: 10.1016/j.nmd.2007.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 12/18/2006] [Accepted: 02/11/2007] [Indexed: 11/24/2022]
Abstract
Mutations in the myosin heavy chain gene (MYH7) can cause several distinct phenotypes depending on the location of the mutation: hypertrophic cardiomyopathy (several exons), myosin storage myopathy (exon 37/39) or Laing distal myopathy (exons 32-36). Here, we describe a unique combination of hypertrophic cardiomyopathy and hypertrophic distal myopathy in a family with a MYH7 Val606Met mutation (exon 16).
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Affiliation(s)
- S Overeem
- Department of Clinical Neurophysiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Bussemaker L, Schelhaas HJ, Overeem S, Hopman WPM, Zwarts MJ. Treatment-responsive pudendal dysfunction in chronic inflammatory demyelinating polyneuropathy. Neurology 2007; 68:957-8. [PMID: 17372137 DOI: 10.1212/01.wnl.0000257130.42352.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- L Bussemaker
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Deboer T, Overeem S, Visser NAH, Duindam H, Frölich M, Lammers GJ, Meijer JH. Convergence of circadian and sleep regulatory mechanisms on hypocretin-1. Neuroscience 2005; 129:727-32. [PMID: 15541893 DOI: 10.1016/j.neuroscience.2004.07.049] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2004] [Indexed: 10/26/2022]
Abstract
Hypocretin is a potential regulator of sleep and wakefulness and its levels fluctuate with the day-night cycle with high levels during the animal's activity period. Whether the daily fluctuations are driven endogenously or by external light cycles is unknown. We investigated the circadian and homeostatic regulation of hypocretin in the absence of environmental light cycles. To this purpose we performed repetitive samplings of cerebrospinal fluid in rats through implanted microcannulas in the cisterna magna and determined hypocretin-1 levels by radioimmunoassay. These experiments were also performed in rats that received a lesion of the suprachiasmatic nucleus (SCN), a major pacemaker for circadian rhythms in mammals. The results showed sustained rhythmicity of hypocretin in constant dim red light in control animals. SCN-lesioned animals showed no circadian rhythms in hypocretin and mean hypocretin levels were remarkably low. The results indicate that the SCN is indispensable for rhythmicity in hypocretin and induces a daily increase in hypocretin levels during the animal's active phase. Additional sleep deprivation experiments were carried out to investigate homeostatic regulation of hypocretin. Hypocretin levels increased in response to sleep deprivation in both control and SCN-lesioned animals, demonstrating that sleep homeostatic control of hypocretin occurs independently from the SCN. Our data indicate that the circadian pacemaker of the SCN and sleep homeostatic mechanisms converge on one single sleep regulatory substance.
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Affiliation(s)
- T Deboer
- Department of Neurophysiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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41
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Kok SW, Roelfsema F, Overeem S, Lammers GJ, Frölich M, Meinders AE, Pijl H. Pulsatile LH release is diminished, whereas FSH secretion is normal, in hypocretin-deficient narcoleptic men. Am J Physiol Endocrinol Metab 2004; 287:E630-6. [PMID: 15172887 DOI: 10.1152/ajpendo.00060.2004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [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] [Indexed: 11/22/2022]
Abstract
Hypocretin (orexin) peptides are involved in the regulation of energy balance and pituitary hormone release. Narcolepsy is a sleep disorder characterized by disruption of hypocretin neurotransmission. Pituitary LH secretion is diminished in hypocretin-deficient animal models, and intracerebroventricular administration of hypocretin-1 activates the hypothalamo-pituitary-gonadal axis in rats. We evaluated whether hypocretin deficiency affects gonadotropin release in humans. To this end, we deconvolved 24-h serum concentrations of LH and FSH in seven hypocretin-deficient narcoleptic males (N) and seven controls (C) matched for age, body mass index, and sex. Basal plasma concentrations of testosterone, estradiol, and sex hormone-binding globulin were similar in both groups. Mean 24-h LH concentration was significantly lower in narcolepsy patients [3.0 +/- 0.4 (N) vs. 4.2 +/- 0.3 (C) U/l, P = 0.01], which was primarily due to a reduction of pulsatile LH secretion [23.5 +/- 1.6 (N) vs. 34.3 +/- 4.9 (C) U.l(-1).24 h(-1), P = 0.02]. The orderliness of LH and FSH secretion, quantitated by the approximate entropy statistic, was greater in patients than in controls. In contrast, all other features of FSH release were similar in narcoleptic and control groups. Also, LH and FSH secretions in response to intravenous administration of 100 microg of GnRH were similar in patients and controls. These data indicate that endogenous hypocretins are involved in the regulation of the hypothalamo-pituitary-gonadal axis activity in humans. In particular, reduced LH release in the face of normal pituitary responsivity to GnRH stimulation in narcoleptic men suggests that hypocretins promote endogenous GnRH secretion.
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Affiliation(s)
- S W Kok
- Leiden University Medical Center, Department of General Internal Medicine, 2300 RC, The Netherlands
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42
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Abstract
Idiopathic narcolepsy is associated with deficient hypocretin transmission. Narcoleptic symptoms have recently been described in paraneoplastic encephalitis with anti-Ma2 antibodies. The authors measured CSF hypocretin-1 levels in six patients with anti-Ma2 encephalitis, and screened for anti-Ma antibodies in patients with idiopathic narcolepsy. Anti-Ma autoantibodies were not detected in patients with idiopathic narcolepsy. Four patients with anti-Ma2 encephalitis had excessive daytime sleepiness; hypocretin-1 was not detectable in their cerebrospinal fluid, suggesting an immune-mediated hypocretin dysfunction.
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Affiliation(s)
- S Overeem
- Department of Neurology, Leiden University Medical Centre, the Netherlands
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43
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Nishino S, Kanbayashi T, Fujiki N, Uchino M, Ripley B, Watanabe M, Lammers GJ, Ishiguro H, Shoji S, Nishida Y, Overeem S, Toyoshima I, Yoshida Y, Shimizu T, Taheri S, Mignot E. CSF hypocretin levels in Guillain-Barre syndrome and other inflammatory neuropathies. Neurology 2003; 61:823-5. [PMID: 14504329 DOI: 10.1212/01.wnl.0000081049.14098.50] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CSF hypocretin-1 was measured in 28 Guillain-Barré syndrome (GBS), 12 Miller-Fisher syndrome, 12 chronic inflammatory demyelinating polyneuropathy (CIDP), and 48 control subjects. Seven GBS subjects had undetectably low hypocretin-1 levels (<100 pg/mL). Hypocretin-1 levels were moderately reduced in an additional 11 GBS, 5 Miller-Fisher syndrome, and 1 CIDP subject. Low levels in GBS occurred early in the disease and were associated with upper CNS level abnormalities.
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Affiliation(s)
- S Nishino
- Stanford University Center for Narcolepsy, Palo Alto, CA 94304, USA.
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Kok SW, Roelfsema F, Overeem S, Lammers GJ, Strijers RL, Frölich M, Meinders AE, Pijl H. Dynamics of the pituitary-adrenal ensemble in hypocretin-deficient narcoleptic humans: blunted basal adrenocorticotropin release and evidence for normal time-keeping by the master pacemaker. J Clin Endocrinol Metab 2002; 87:5085-91. [PMID: 12414876 DOI: 10.1210/jc.2002-020638] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [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] [Indexed: 11/19/2022]
Abstract
Narcolepsy is a sleep disorder caused by disruption of hypocretin (orexin) neurotransmission. It has been suggested that anomalous timing by the biological clock contributes to the symptomatology. Hypocretins stimulate the pituitary-adrenal (PA) axis in rodents. We explored whether hypocretin deficiency disrupts circadian timing and blunts PA hormone release. We deconvolved 24-h plasma profiles of ACTH and cortisol, and determined their circadian rhythm by cosinor analysis in seven hypocretin-deficient narcoleptic males and seven matched controls. Basal and total ACTH production were blunted in narcoleptics [310 +/- 86 vs. 760 +/-160 ng/liter.24 h (P = 0.02) and 920 +/- 147 vs. 1460 +/- 220 ng/liter.24 h (P = 0.04), respectively], whereas pulsatile release did not differ between groups. In contrast, basal, pulsatile and total cortisol secretion were similar in both groups. The cross-approximate entropy of the joint ACTH/cortisol time series was higher in narcoleptics (1.26 +/- 0.07 vs. 1.07 +/- 0.04; P = 0.04), reflecting reduced secretory process regularity. The acrophases of both ACTH and cortisol occurred at similar clock times (approximately 0830 h) in patients and controls, which supports the idea that the master pacemaker is intact in narcolepsy. The reduced (basal) ACTH secretion and the diminished secretory process regularity of the ACTH/cortisol ensemble conjointly suggest that hypocretin deficiency induces changes in the interplay between PA hormones.
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Affiliation(s)
- S W Kok
- Department of General Internal Medicine (C1-R38), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Lammers GJ, Overeem S. [Unwanted 'siesta']. Ned Tijdschr Geneeskd 2002; 146:493; author reply 493-4. [PMID: 11913116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Overeem S, van Hilten JJ, Ripley B, Mignot E, Nishino S, Lammers GJ. Normal hypocretin-1 levels in Parkinson's disease patients with excessive daytime sleepiness. Neurology 2002; 58:498-9. [PMID: 11839864 DOI: 10.1212/wnl.58.3.498] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Overeem
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, 2300 RC Leiden, the Netherlands
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Kok SW, Meinders AE, Overeem S, Lammers GJ, Roelfsema F, Frölich M, Pijl H. Reduction of plasma leptin levels and loss of its circadian rhythmicity in hypocretin (orexin)-deficient narcoleptic humans. J Clin Endocrinol Metab 2002; 87:805-9. [PMID: 11836325 DOI: 10.1210/jcem.87.2.8246] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [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] [Indexed: 11/19/2022]
Abstract
Recent observations have implicated hypocretin deficiency in the pathogenesis of narcolepsy. Hypocretin neurotransmission also affects energy balance, and narcoleptic patients tend to become obese. Because hypocretins appear to have important neuroendocrine effects, we hypothesized that the neuroendocrine systems that regulate energy balance might be distinctly set in narcolepsy. As leptin is a pivotal part of these systems, we explored the 24-h plasma leptin (20-min sampling interval) concentration profile in six narcoleptic males and six normal controls, matched for age, sex, body mass index, waist/hip ratio, and fat mass. We thus demonstrated a reduction of the mean 24-h leptin concentration in narcoleptics to 52% of that in controls (5.9 microg/liter in narcolepsy vs. 11.4 microg/liter in controls; P < 0.05). Further, a nocturnal acrophase (clock time of the highest concentration), which is typical of normal leptin secretion, was observed in controls (mean, 2335 h; 95% confidence interval, 2105-0205 h), but not in narcoleptic patients. The mechanisms that potentially disturb the circadian rhythm of leptin levels in hypocretin-deficient narcoleptic humans include anomalies of the sleep-wake cycle and/or disruption of the circadian distribution of autonomic activity. As leptin deficiency clearly leads to morbid obesity in experimental animals and humans, we infer that the observed reduction of plasma leptin levels may predispose narcoleptic humans to weight gain.
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Affiliation(s)
- S W Kok
- Department of General Internal Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
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Nevsímalová S, Vanková J, Sonka K, Faraco J, Rogers W, Overeem S, Mignot E. [Hypocretin (orexin) deficiency in narcolepsy-cataplexy]. Sb Lek 2002; 101:381-6. [PMID: 11702580] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
A mutation in the HCRT locus was proved in 18-yrs old male suffering from narcolepsy-cataplexy. He has demonstrated cataplectic attacks (brief spells of head dropping provoked by laughter) as well as imperative sleep in spells of several minutes up to one hour since the age of six months. He has suffered from severe bulimia since five years; later hypnagogic hallucinations, sleep paralysis and unquiet nocturnal sleep accompanied by periodic limb movements appeared. Symptoms are partially controlled with methylphenidate and either imipramine, clomipramine or fluoxetine. Periodic leg movements poorly responded to L-DOPA and clonazepam treatment. He is HLA-DQB1*0602 negative. Repeated MSLT (over 16 years followed-up period) showed extremely short latency with predominant SOREMPs and also nocturnal PSG recordings revealed fragmented sleep with SOREMPs. This case report demonstrates that hypocretin (orexin) mutations in human can produce the full narcolepsy phenotype and validates data recently reported in dog and mouse models suggesting a role for hypocretin (orexin) in the pathophysiology of narcolepsy and the regulation of REM sleep.
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Affiliation(s)
- S Nevsímalová
- Neurologická klinika 1. lékarské fakulty, Univerzity Karlovy a Vseobecné fakultní nemocnice, Katerinská 30, 120 00 Praha 2, Czech Republic.
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Commissaris DACM, Nieuwenhuijzen PHJA, Overeem S, de Vos A, Duysens JEJ, Bloem BR. Dynamic posturography using a new movable multidirectional platform driven by gravity. J Neurosci Methods 2002; 113:73-84. [PMID: 11741724 DOI: 10.1016/s0165-0270(01)00477-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [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: 11/25/2022]
Abstract
Human upright balance control can be quantified using movable platforms driven by servo-controlled torque motors (dynamic posturography). We introduce a new movable platform driven by the force of gravity acting upon the platform and the subject standing on it. The platform consists of a 1 m2 metal plate, supported at each of its four corners by a cable and two magnets. Sudden release of the magnets on three sides of the platform (leaving one side attached) induces rotational perturbations in either the pitch or roll plane. Release of all magnets causes a purely vertical displacement. By varying the slack in the supporting cables, the platform can generate small (0.5 degrees ) to very destabilising (19 degrees ) rotations. Experiments in healthy subjects showed that the platform generated standardised and reproducible perturbations. The peak rotation velocity well exceeded the threshold required to elicit postural responses in the leg muscles. Onset latencies were comparable to those evoked by torque motor-driven platforms. Randomly mixed multidirectional perturbations of large amplitude forced the subject to use compensatory steps (easily possible on the large support surface), with little confounding influence of habituation. We conclude that this gravity-driven multidirectional platform provides a useful and versatile tool for dynamic posturography.
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Affiliation(s)
- D A C M Commissaris
- Department of Medical Physics and Biophysics, University of Nijmegen, Nijmegen, The Netherlands
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50
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Ripley B, Overeem S, Fujiki N, Nevsimalova S, Uchino M, Yesavage J, Di Monte D, Dohi K, Melberg A, Lammers GJ, Nishida Y, Roelandse FW, Hungs M, Mignot E, Nishino S. CSF hypocretin/orexin levels in narcolepsy and other neurological conditions. Neurology 2001; 57:2253-8. [PMID: 11756606 DOI: 10.1212/wnl.57.12.2253] [Citation(s) in RCA: 238] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the specificity of low CSF hypocretin-1 levels in narcolepsy and explore the potential role of hypocretins in other neurologic disorders. METHODS A method to measure hypocretin-1 in 100 microL of crude CSF sample was established and validated. CSF hypocretin-1 was measured in 42 narcolepsy patients (ages 16-70 years), 48 healthy controls (ages 22-77 years,) and 235 patients with various other neurologic conditions (ages 0-85 years). RESULTS As previously reported, CSF hypocretin-1 levels were undetectably low (<100 pg/mL) in 37 of 42 narcolepsy subjects. Hypocretin-1 levels were detectable in all controls (224-653 pg/mL) and all neurologic patients (117-720 pg/mL), with the exception of three patients with Guillain-Barré syndrome (GBS). Hypocretin-1 was within the control range in most neurologic patients tested, including patients with AD, PD, and MS. Low but detectable levels (100-194 pg/mL) were found in a subset of patients with acute lymphocytic leukemia, intracranial tumors, craniocerebral trauma, CNS infections, and GBS. CONCLUSIONS Undetectable CSF hypocretin-1 levels are highly specific to narcolepsy and rare cases of GBS. Measuring hypocretin-1 levels in the CSF of patients suspected of narcolepsy is a useful diagnostic procedure. Low hypocretin levels are also observed in a large range of neurologic conditions, most strikingly in subjects with head trauma. These alterations may reflect focal lesions in the hypothalamus, destruction of the blood brain barrier, or transient or chronic hypofunction of the hypothalamus. Future research in this area is needed to establish functional significance.
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Affiliation(s)
- B Ripley
- Stanford University Center for Narcolepsy, Palo Alto, CA 94304, USA
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