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Olsen M, Zeitzer JM, Nakase-Richardson R, Musgrave VH, Sorensen HBD, Mignot E, Jennum PJ. A deep transfer learning approach for sleep stage classification and sleep apnea detection using wrist-worn consumer sleep technologies. IEEE Trans Biomed Eng 2024; PP:1-12. [PMID: 38498753 DOI: 10.1109/tbme.2024.3378480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Obstructive sleep apnea (OSA) is a common, underdiagnosed sleep-related breathing disorder with serious health implications Objective - We propose a deep transfer learning approach for sleep stage classification and sleep apnea (SA) detection using wrist-worn consumer sleep technologies (CST). Methods - Our model is based on a deep convolutional neural network (DNN) utilizing accelerometers and photo-plethysmography signals from nocturnal recordings. The DNN was trained and tested on internal datasets that include raw data from clinical and wrist-worn devices; external validation was performed on a hold-out test dataset containing raw data from a wrist-worn CST. Results - Training on clinical data improves performance significantly, and feature enrichment through a sleep stage stream gives only minor improvements. Raw data input outperforms feature-based input in CST datasets. The system generalizes well but performs slightly worse on wearable device data compared to clinical data. However, it excels in detecting events during REM sleep and is associated with arousal and oxygen desaturation. We found; cases that were significantly underestimated were characterized by fewer of such event associations. Conclusion - This study showcases the potential of using CSTs as alternate screening solution for undiagnosed cases of OSA. Significance - This work is significant for its development of a deep transfer learning approach using wrist-worn consumer sleep technologies, offering comprehensive validation for data utilization, and learning techniques, ultimately improving sleep apnea detection across diverse devices.
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Paulsrud C, Thorsen SU, Helms P, Weis MSF, Karacan MN, Lydolph SR, Ranjan AG, Leonthin H, Jennum PJ, Svensson J, Mol Debes N. Validation of the newly developed Sleep Screening Questionnaire Children and Adolescents (SSQ-CA) with objective sleep measures. Sleep Med 2023; 112:359-367. [PMID: 37979560 DOI: 10.1016/j.sleep.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Objectively validated pediatric sleep questionnaires covering a broader age range and different sleep disturbances are lacking, therefore we developed the Sleep Screening Questionnaire Children and Adolescents (SSQ-CA) and compared it with objective sleep parameters. METHODS This child-reported questionnaire was developed by a multidisciplinary panel and face validated. In a cross-sectional prospective design, participants aged 6-17, answered the questionnaire twice with 21-28 days in between, wore actigraphy (AG) and kept a sleep diary for seven nights and home-polysomnography (PSG) for one of these nights. Exploratory factor analyses (EFA), reliability and validity assessments were performed. RESULTS Of the 139 participants, 128 (F:47.7%, AG: n = 128, PSG: n = 59), were included in the analyses. Mean age: 11.3 years (SD: 2.9). EFA revealed 11 factors and 40 items loading above r = 0.4. Subscale internal consistency: 0.54-0.92. Subscale test-retest reliability: r = 0.71-0.87. Total sleep time (TST) from SSQ-CA on weekdays correlated with PSG (r = 0.48, p = 0.001) and with AG (r = 0.75, p < 0.001). The subscale total score for "Sleep duration and latency" correlated with TST from AG (r = -0.19, p = 0.03) and sleep latency (r = 0.31, p < 0.001), but not for PSG variables. The subscale "Awakenings" showed no correlation with objective measures whereas "Circadian rhythm" correlated to AG-derived mid-sleep time (r = 0.34, p < 0.001). CONCLUSIONS The SSQ-CA shows adequate reliability for the 6-17-year-olds and acceptable criterion validity for two subscales. It appears to be a useful tool for screening for sleep disturbances in combination with objective tools as the subjective and objective parameters seem to uncover different aspects of sleep.
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Affiliation(s)
- Cecilie Paulsrud
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark.
| | | | - Pernille Helms
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Mia Sofie F Weis
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Munise N Karacan
- Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Siff R Lydolph
- Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | | | | | | | - Jannet Svensson
- Steno Diabetes Center Copenhagen, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark
| | - Nanette Mol Debes
- Department of Pediatrics, Herlev and Gentofte University Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Latocha KM, Løppenthin KB, Østergaard M, Jennum PJ, Hetland ML, Røgind H, Lundbak T, Midtgaard J, Christensen R, Esbensen BA. The effect of group-based cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis: a randomized controlled trial. Rheumatology (Oxford) 2023; 62:1097-1107. [PMID: 35951745 DOI: 10.1093/rheumatology/keac448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The primary objective was to compare the effect of cognitive behavioural therapy for insomnia (CBT-I) to usual care on sleep efficiency, measured by polysomnography (PSG) immediately after the intervention at week 7. Secondary objectives included comparing the longer-term effect on sleep- and RA-related outcomes at week 26. METHODS In a randomized controlled trial using a parallel group design, the experimental intervention was 6 weeks' nurse-led group-based CBT-I; the comparator was usual care. Analyses were based on the intention-to-treat (ITT) principle; missing data were statistically modelled using repeated-measures linear mixed effects models adjusted for the level at baseline. RESULTS The ITT population consisted of 62 patients (89% women), with an average age of 58 years and an average sleep efficiency of 83.1%. At primary end point, sleep efficiency was 88.7% in the CBT-I group, compared with 83.7% in the control group (difference: 5.03 [95% CI -0.37, 10.43]; P = 0.068) measured by PSG at week 7. Key secondary outcomes measured with PSG had not improved at week 26. However, for all the patient-reported key secondary sleep- and RA-related outcomes, there were statistically highly significant differences between CBT-I and usual care (P < 0.0001), e.g. insomnia (Insomnia Severity Index: -9.85 [95% CI -11.77, -7.92]) and the RA impact of disease (RAID: -1.36 [95% CI -1.92, -0.80]) at week 26. CONCLUSION Nurse-led group-based CBT-I did not lead to an effect on sleep efficiency objectively measured with PSG. However, CBT-I showed improvement on all patient-reported key secondary sleep- and RA-related outcomes measured at week 26. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT03766100.
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Affiliation(s)
- Kristine M Latocha
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Glostrup.,Section for Biostatistics and Evidence-Based Research, The Parker Institute, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen
| | - Katrine B Løppenthin
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet.,Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Poul J Jennum
- Department of Clinical Medicine, University of Copenhagen, Copenhagen.,Danish Center for Sleep Medicine, Department of Clinical Neurophysiology
| | - Merete L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Henrik Røgind
- Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet
| | - Tine Lundbak
- Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen.,Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, University of Copenhagen, Glostrup
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Bente A Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen
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Latocha KM, Løppenthin KB, Al-Bazy S, Albrechtsen TL, Jensen HE, Østergaard M, Jennum PJ, Esbensen BA, Christensen R. Impact of Nonpharmacologic Interventions Targeting Sleep Disturbances or Disorders in Patients With Inflammatory Arthritis: A Systematic Review and Meta-Analysis of Randomized Trials. Arthritis Care Res (Hoboken) 2022; 74:2108-2118. [PMID: 34121362 DOI: 10.1002/acr.24731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/28/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Patients with inflammatory arthritis have a high risk of sleep disturbances and disorders. The objective was to evaluate the evidence of nonpharmacologic interventions targeting sleep disturbances or disorders in patients with inflammatory arthritis. METHODS A systematic search was undertaken from inception to September 8, 2020. We included randomized trials concerning nonpharmacologic interventions applied in adults with inflammatory arthritis and concomitant sleep disturbances or disorders. The primary outcome was the sleep domain, while secondary outcomes were core outcome domains for inflammatory arthritis trials and harms. The Cochrane Risk of Bias tool was applied, and the overall quality of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. Effect sizes for continuous outcomes were based on the standardized mean difference, combined using random-effects meta-analysis. RESULTS Six trials (308 patients) were included in the quantitative synthesis; 3 of these reported improvement in sleep in favor of the nonpharmacologic interventions. The meta-analysis of the sleep domains indicated a large clinical effect of -0.80 (95% confidence interval -1.33, -0.28) in favor of nonpharmacologic interventions targeting sleep disturbances or disorders. The estimate was rated down twice for risk of bias and unexplained inconsistency; this risk was assessed as corresponding to low-quality evidence. None of the secondary core outcomes used in contemporary inflammatory arthritis trials indicated a clinical benefit in favor of nonpharmacologic interventions targeting sleep. CONCLUSION Nonpharmacologic interventions targeting sleep disturbances/disorders in patients with inflammatory arthritis indicated a promising effect on sleep outcomes, but not yet with convincing evidence.
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Affiliation(s)
| | | | | | | | | | | | - Poul J Jennum
- Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Bente A Esbensen
- Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Robin Christensen
- Bispebjerg and Frederiksberg Hospital, Copenhagen, and University of Southern Denmark, Odense, Denmark
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Rasmussen JØ, Nordholm D, Glenthøj LB, Jensen MA, Garde AH, Ragahava JM, Jennum PJ, Glenthøj BY, Nordentoft M, Baandrup L, Ebdrup BH, Kristensen TD. White matter microstructure and sleep-wake disturbances in individuals at ultra-high risk of psychosis. Front Hum Neurosci 2022; 16:1029149. [PMID: 36393990 PMCID: PMC9649829 DOI: 10.3389/fnhum.2022.1029149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/07/2022] [Indexed: 11/25/2022] Open
Abstract
Aim White matter changes in individuals at ultra-high risk for psychosis (UHR) may be involved in the transition to psychosis. Sleep-wake disturbances commonly precede the first psychotic episode and predict development of psychosis. We examined associations between white matter microstructure and sleep-wake disturbances in UHR individuals compared to healthy controls (HC), as well as explored the confounding effect of medication, substance use, and level of psychopathology. Methods Sixty-four UHR individuals and 35 HC underwent clinical interviews and diffusion weighted imaging. Group differences on global and callosal mean fractional anisotropy (FA) was tested using general linear modeling. Sleep-wake disturbances were evaluated using the subjective measures disturbed sleep index (DSI) and disturbed awakening index (AWI) from the Karolinska Sleep Questionnaire, supported by objective sleep measures from one-night actigraphy. The primary analyses comprised partial correlation analyses between global FA/callosal FA and sleep-wake measures. Secondary analyses investigated multivariate patterns of covariance between measures of sleep-wake disturbances and FA in 48 white matter regions of interest using partial least square correlations. Results Ultra-high risk for psychosis individuals displayed lower global FA (F = 14.56, p < 0.001) and lower callosal FA (F = 11.34, p = 0.001) compared to HC. Subjective sleep-wake disturbances were significantly higher among the UHR individuals (DSI: F = 27.59, p < 0.001, AWI: F = 36.42, p < 0.001). Lower callosal FA was correlated with increased wake after sleep onset (r = -0.34, p = 0.011) and increased sleep fragmentation index (r = -0.31, p = 0.019) in UHR individuals. Multivariate analyses identified a pattern of covariance in regional FA which were associated with DSI and AWI in UHR individuals (p = 0.028), but not in HC. Substance use, sleep medication and antipsychotic medication did not significantly confound these associations. The association with objective sleep-wake measures was sustained when controlling for level of depressive and UHR symptoms, but symptom level confounded the covariation between FA and subjective sleep-wake measures in the multivariate analyses. Conclusion Compromised callosal microstructure in UHR individuals was related to objectively observed disruptions in sleep-wake functioning. Lower FA in ventrally located regions was associated with subjectively measured sleep-wake disturbances and was partly explained by psychopathology. These findings call for further investigation of sleep disturbances as a potential treatment target.
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Affiliation(s)
- Jesper Ø. Rasmussen
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Dorte Nordholm
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Louise B. Glenthøj
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie A. Jensen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Anne H. Garde
- The National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jayachandra M. Ragahava
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Poul J. Jennum
- Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birte Y. Glenthøj
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lone Baandrup
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Bjørn H. Ebdrup
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina D. Kristensen
- Centre for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
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Olsen M, Zeitzer JM, Richardson RN, Davidenko P, Jennum PJ, Sorensen HBD, Mignot E. A flexible deep learning architecture for temporal sleep stage classification using accelerometry and photoplethysmography. IEEE Trans Biomed Eng 2022; 70:228-237. [PMID: 35786544 DOI: 10.1109/tbme.2022.3187945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Wrist-worn consumer sleep technologies (CST) that contain accelerometers (ACC) and photoplethysmography (PPG) are increasingly common and hold great potential to function as out-of-clinic (OOC) sleep monitoring systems. However, very few validation studies exist because raw data from CSTs are rarely made accessible for external use. We present a deep neural network (DNN) with a strong temporal core, inspired by U-Net, that can process multivariate time series inputs with different dimensionality to predict sleep stages (wake, light-, deep-, and REM sleep) using ACC and PPG signals from nocturnal recordings. The DNN was trained and tested on 3 internal datasets, comprising raw data both from clinical and wrist-worn devices from 301 recordings (PSG-PPG: 266, Wrist-worn PPG: 35). External validation was performed on a hold-out test dataset containing 35 recordings comprising only raw data from a wrist-worn CST. An accuracy = 0.71±0.09, 0.76±0.07, 0.73±0.06, and κ = 0.58±0.13, 0.64±0.09, 0.59±0.09 was achieved on the internal test sets. Our experiments show that spectral preprocessing yields superior performance when compared to surrogate-, feature-, raw data-based preparation. Combining both modalities produce the overall best performance, although PPG proved to be the most impactful and was the only modality capable of detecting REM sleep well. Including ACC improved model precision to wake and sleep metric estimation. Increasing input segment size improved performance consistently; the best performance was achieved using 1024 epochs (∼8.5 hrs.). An accuracy = 0.69±0.13 and κ = 0.58±0.18 was achieved on the hold-out test dataset, proving the generalizability and robustness of our approach to raw data collected with a wrist-worn CST.
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Pickering L, Main KM, Sehested A, Mathiasen R, Feldt-Rasmussen U, Klose M, Kotagal S, Jennum PJ. Brain tumours result in sleep disorders in children and adolescents. Sleep Med 2021; 88:13-21. [PMID: 34715527 DOI: 10.1016/j.sleep.2021.09.016] [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: 03/05/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Sleep disturbances are frequently reported in children with brain tumours. The objective of our cross-sectional study was to systematically examine sleep in these children. We hypothesised that children with tumours involving the sleep-wake-regulatory areas have an altered sleep-wake-regulation. METHODS Sixty-one patients aged 0-18 years and with a diagnosis of a primary brain or cervical medullary tumour were included. They were categorised based upon tumour location into two groups - those affecting the sleep-wake regulatory regions, i.e. brain stem, basal forebrain, hypothalamus, thalamus, and posterior fossa compressing the brain stem and those that did not. Sleep history, questionnaire surveys, polysomnography, and multiple sleep latency test were used, as indicated clinically. Surveys included Pediatric Daytime Sleepiness Scale, Children's Sleep Habits Questionnaire, Strengths and Difficulties Questionnaire, and Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale and Generic Core Scale. RESULTS Patients with tumours involving the sleep-wake regulatory areas were sleepier/more fatigued (p = 0.03). Sleep apnoea was observed in 86% of all the patients and comorbid narcolepsy in 8%, without group differences (p ≥ 0.12). Patients with tumours involving the sleep-wake-regulatory areas had more emotional problems (p = 0.04), were more affected by mental health problems (p < 0.001), and had poorer quality of life (p ≤ 0.03). CONCLUSIONS Many children with brain tumours suffer from disturbed sleep, poor mental health, and low quality of life. We recommend that systematic sleep evaluation is included in their routine care along with psychological and social support.
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Affiliation(s)
- Line Pickering
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 17, DK-2600, Glostrup, Denmark.
| | - Katharina M Main
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Ulla Feldt-Rasmussen
- Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark; Department of Medical Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Suresh Kotagal
- Department of Neurology and the Center for Sleep Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 17, DK-2600, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
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Baandrup L, Jennum PJ. Effect of a dynamic lighting intervention on circadian rest-activity disturbances in cognitively impaired, older adults living in a nursing home: A proof-of-concept study. Neurobiol Sleep Circadian Rhythms 2021; 11:100067. [PMID: 34095610 PMCID: PMC8167295 DOI: 10.1016/j.nbscr.2021.100067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/16/2021] [Accepted: 05/16/2021] [Indexed: 12/29/2022] Open
Abstract
Development of non-pharmacological interventions to improve disrupted rest-activity patterns and disturbed behavior in people with dementia is an important research goal. Here we report a proof-of-concept study which evaluates the effect and applicability of a dynamic light intervention to improve rest-activity patterns in cognitively impaired, institutionalized, older adults. The study was a randomized, open-label, proof-of-concept trial of limited sample size conducted at a nursing home for older adults in a non-metropolitan area in Denmark. Participants were 24 older nursing home residents with cognitive deficiencies. Equipment for delivery of a specialized dynamic light intervention was installed in the private apartments (within the nursing home) of the residents in the experimental group (N = 12). Study duration was four weeks. The control group (N = 12) was exposed to conventional lighting. We measured activity and rest using actigraphy, functional disability, behavioral disturbances, and time in bed We performed regression analyses to examine differences between the intervention groups. Participants in the experimental group partially improved on one of three diurnal rhythm variables, but otherwise no differences were observed between the two intervention groups. The improvement was found for the intradaily variability during the first part of the intervention period indicating a more stable and less fragmented 24-h rest-activity rhythm. However, availability of staff assistance in response to impaired physical mobility of the residents seemed to be a stronger determinant of activity level and pattern. The examined intervention showed promising results but did not consistently alter circadian rest-activity patterns in older nursing home residents given the current sample size. Future studies in the field need to consider real-life applicability of the experimental intervention and the interaction and importance of other important zeitgebers than light. Circadian rest-activity disturbances are frequent in nursing home residents. Dynamic lighting might stabilize certain aspects of circadian disruption. Future interventions should include zeitgebers other than light.
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Affiliation(s)
- Lone Baandrup
- Mental Health Center Glostrup, Mental Health Services of the Capital Region, Nordstjernevej 41, 2600 Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark.,Mental Health Center Copenhagen, Mental Health Services of the Capital Region, Tuborgvej 235, 2400 Copenhagen NV, Denmark
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Copenhagen University Hospital, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
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Ægidius HM, Kruse L, Christensen GL, Lorentzen MP, Jørgensen NR, Moresco M, Pizza F, Plazzi G, Jennum PJ, Kornum BR. Pre-treatment of blood samples reveal normal blood hypocretin/orexin signal in narcolepsy type 1. Brain Commun 2021; 3:fcab050. [PMID: 33977264 PMCID: PMC8100001 DOI: 10.1093/braincomms/fcab050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 12/11/2022] Open
Abstract
The hypocretin/orexin system regulates arousal through central nervous system mechanisms and plays an important role in sleep, wakefulness and energy homeostasis. It is unclear whether hypocretin peptides are also present in blood due to difficulties in measuring reliable and reproducible levels of the peptides in blood samples. Lack of hypocretin signalling causes the sleep disorder narcolepsy type 1, and low concentration of cerebrospinal fluid hypocretin-1/orexin-A peptide is a hallmark of the disease. This measurement has high diagnostic value, but performing a lumbar puncture is not without discomfort and possible complications for the patient. A blood-based test to assess hypocretin-1 deficiency would therefore be of obvious benefit. We here demonstrate that heating plasma or serum samples to 65°C for 30 min at pH 8 significantly increases hypocretin-1 immunoreactivity enabling stable and reproducible measurement of hypocretin-1 in blood samples. Specificity of the signal was verified by high-performance liquid chromatography and by measuring blood samples from mice lacking hypocretin. Unspecific background signal in the assay was high. Using our method, we show that hypocretin-1 immunoreactivity in blood samples from narcolepsy type 1 patients does not differ from the levels detected in control samples. The data presented here suggest that hypocretin-1 is present in the blood stream in the low picograms per millilitres range and that peripheral hypocretin-1 concentrations are unchanged in narcolepsy type 1.
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Affiliation(s)
- Helene M Ægidius
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Lars Kruse
- Department of Clinical Biochemistry, Rigshospitalet, 2600 Glostrup, Denmark
| | | | - Marc P Lorentzen
- Department of Clinical Biochemistry, Rigshospitalet, 2600 Glostrup, Denmark
| | - Niklas R Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, 2600 Glostrup, Denmark
| | - Monica Moresco
- Istituto delle Scienze Neurologiche, Ospedale Bellaria, IRCCS Bologna, 40139 Bologna, Italy
| | - Fabio Pizza
- Istituto delle Scienze Neurologiche, Ospedale Bellaria, IRCCS Bologna, 40139 Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
| | - Giuseppe Plazzi
- Istituto delle Scienze Neurologiche, Ospedale Bellaria, IRCCS Bologna, 40139 Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, 41121 Modena, Italy
| | - Poul J Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, 2600 Glostrup, Denmark
| | - Birgitte R Kornum
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen N, Denmark
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Didriksen M, Nawaz MS, Dowsett J, Bell S, Erikstrup C, Pedersen OB, Sørensen E, Jennum PJ, Burgdorf KS, Burchell B, Butterworth AS, Soranzo N, Rye DB, Trotti LM, Saini P, Stefansdottir L, Magnusson SH, Thorleifsson G, Sigmundsson T, Sigurdsson AP, Van Den Hurk K, Quee F, Tanck MWT, Ouwehand WH, Roberts DJ, Earley EJ, Busch MP, Mast AE, Page GP, Danesh J, Di Angelantonio E, Stefansson H, Ullum H, Stefansson K. Large genome-wide association study identifies three novel risk variants for restless legs syndrome. Commun Biol 2020; 3:703. [PMID: 33239738 PMCID: PMC7689502 DOI: 10.1038/s42003-020-01430-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/21/2020] [Indexed: 02/02/2023] Open
Abstract
Restless legs syndrome (RLS) is a common neurological sensorimotor disorder often described as an unpleasant sensation associated with an urge to move the legs. Here we report findings from a meta-analysis of genome-wide association studies of RLS including 480,982 Caucasians (cases = 10,257) and a follow up sample of 24,977 (cases = 6,651). We confirm 19 of the 20 previously reported RLS sequence variants at 19 loci and report three novel RLS associations; rs112716420-G (OR = 1.25, P = 1.5 × 10-18), rs10068599-T (OR = 1.09, P = 6.9 × 10-10) and rs10769894-A (OR = 0.90, P = 9.4 × 10-14). At four of the 22 RLS loci, cis-eQTL analysis indicates a causal impact on gene expression. Through polygenic risk score for RLS we extended prior epidemiological findings implicating obesity, smoking and high alcohol intake as risk factors for RLS. To improve our understanding, with the purpose of seeking better treatments, more genetics studies yielding deeper insights into the disease biology are needed.
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Affiliation(s)
- Maria Didriksen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
- deCODE Genetics, 101, Reykjavik, Iceland
| | - Muhammad Sulaman Nawaz
- deCODE Genetics, 101, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101, Reykjavik, Iceland
| | - Joseph Dowsett
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Steven Bell
- The National Institute for Health Research Blood and Transplant Unit in Donor Health and Genomics, University of Cambridge, Cambridge, CB1 8RN, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole B Pedersen
- Department of Clinical Immunology, Nastved Sygehus, Nastved, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Poul J Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
- Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer S Burgdorf
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Brendan Burchell
- Faculty of Human, Social and Political Sciences, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Adam S Butterworth
- The National Institute for Health Research Blood and Transplant Unit in Donor Health and Genomics, University of Cambridge, Cambridge, CB1 8RN, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Nicole Soranzo
- The National Institute for Health Research Blood and Transplant Unit in Donor Health and Genomics, University of Cambridge, Cambridge, CB1 8RN, UK
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0PT, UK
- Department of Human Genetics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1HH, UK
| | - David B Rye
- Department of Neurology and Program in Sleep, Emory University, Atlanta, GA, USA
| | - Lynn Marie Trotti
- Department of Neurology and Program in Sleep, Emory University, Atlanta, GA, USA
| | - Prabhjyot Saini
- Department of Neurology and Program in Sleep, Emory University, Atlanta, GA, USA
| | | | | | | | - Thordur Sigmundsson
- Faculty of Medicine, University of Iceland, 101, Reykjavik, Iceland
- Department of Psychiatry, Telemark Hospital Trust, Skien, Norway
| | | | - Katja Van Den Hurk
- Department of Donor Studies, Sanquin Research, 1066 CX, Amsterdam, The Netherlands
| | - Franke Quee
- Department of Donor Studies, Sanquin Research, 1066 CX, Amsterdam, The Netherlands
| | - Michael W T Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem H Ouwehand
- The National Institute for Health Research Blood and Transplant Unit in Donor Health and Genomics, University of Cambridge, Cambridge, CB1 8RN, UK
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0PT, UK
- Department of Human Genetics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1HH, UK
| | - David J Roberts
- The National Institute for Health Research Blood and Transplant Unit in Donor Health and Genomics, University of Cambridge, Cambridge, CB1 8RN, UK
- National Health Service (NHS) Blood and Transplant and Radcliffe Department of Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, John Radcliffe Hospital, Oxford, UK
- BRC Haematology Theme and Department of Haematology, Churchill Hospital, Oxford, UK
| | - Eric J Earley
- RTI International, Research Triangle Park, Durham, NC, USA
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA, USA
- Department of Laboratory Medicine, University of San Francisco, San Francisco, CA, USA
| | - Alan E Mast
- Blood Research Institute, Versiti, Milwaukee, WI, USA
| | | | - John Danesh
- The National Institute for Health Research Blood and Transplant Unit in Donor Health and Genomics, University of Cambridge, Cambridge, CB1 8RN, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
- Department of Human Genetics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1HH, UK
| | - Emanuele Di Angelantonio
- The National Institute for Health Research Blood and Transplant Unit in Donor Health and Genomics, University of Cambridge, Cambridge, CB1 8RN, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | | | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark.
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Lammers GJ, Bassetti CL, Dolenc-Groselj L, Jennum PJ, Kallweit U, Khatami R, Lecendreux M, Manconi M, Mayer G, Partinen M, Plazzi G, Reading PJ, Santamaria J, Sonka K, Dauvilliers Y. Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts. Sleep Med Rev 2020; 52:101306. [DOI: 10.1016/j.smrv.2020.101306] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 01/22/2023]
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Latocha KM, Løppenthin KB, Østergaard M, Jennum PJ, Christensen R, Hetland M, Røgind H, Lundbak T, Midtgaard J, Esbensen BA. Cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis: protocol for the randomised, single-blinded, parallel-group Sleep-RA trial. Trials 2020; 21:440. [PMID: 32471477 PMCID: PMC7257190 DOI: 10.1186/s13063-020-04282-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/26/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND More than half of patients with rheumatoid arthritis complain of insomnia, which is predominantly treated with hypnotic drugs. However, cognitive behavioural therapy for insomnia is recommended as the first-line treatment in international guidelines on sleep. Patients with rheumatoid arthritis suffer from debilitating symptoms, such as fatigue and pain, which can also be linked to sleep disturbance. It remains to be determined whether cognitive behavioural therapy for insomnia can be effective in patients with rheumatoid arthritis. The aim of the Sleep-RA trial is to investigate the efficacy of cognitive behavioural therapy for insomnia on sleep and disease-related symptoms in patients with rheumatoid arthritis. The primary objective is to compare the effect of cognitive behavioural therapy for insomnia relative to usual care on changes in sleep efficiency from baseline to week 7 in patients with rheumatoid arthritis. The key secondary objectives are to compare the effect of cognitive behavioural therapy for insomnia relative to usual care on changes in sleep onset latency, wake after sleep onset, total sleep time, insomnia, sleep quality, fatigue, impact of rheumatoid arthritis and depressive symptoms from baseline to week 26 in patients with rheumatoid arthritis. METHODS The Sleep-RA trial is a randomised controlled trial with a two-group parallel design. Sixty patients with rheumatoid arthritis, insomnia and low-to-moderate disease activity will be allocated 1:1 to treatment with cognitive behavioural therapy for insomnia or usual care. Patients in the intervention group will receive nurse-led, group-based cognitive behavioural therapy for insomnia once a week for 6 weeks. Outcome assessments will be carried out at baseline, after treatment (week 7) and at follow-up (week 26). DISCUSSION Data on treatment of insomnia in patients with rheumatoid arthritis are sparse. The Sleep-RA trial is the first randomised controlled trial to investigate the efficacy of cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis. Because symptoms of rheumatoid arthritis and insomnia have many similarities, we also find it relevant to investigate the secondary effects of cognitive behavioural therapy for insomnia on fatigue, impact of rheumatoid arthritis, depressive symptoms, pain, functional status, health-related quality of life and disease activity. If we find cognitive behavioural therapy for insomnia to be effective in patients with rheumatoid arthritis this will add weight to the argument that evidence-based non-pharmacological treatment for insomnia in rheumatological outpatient clinics is eligible in accordance with the existing international guidelines on sleep. TRIAL REGISTRATION ClinicalTrials.gov: NCT03766100. Registered on 30 November 2018.
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Affiliation(s)
- K M Latocha
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.
| | - K B Løppenthin
- Department of Oncology, Research unit for Cancer Late Effect, CASTLE, Rigshospitalet, Copenhagen, Denmark
| | - M Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P J Jennum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - M Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Røgind
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - T Lundbak
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - J Midtgaard
- The University Hospitals Centre for Health Research, Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B A Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Waser M, Garn H, Jennum PJ, Sorensen HBD. A Blind Source-Based Method for Automated Artifact-Correction in Standard Sleep EEG. Annu Int Conf IEEE Eng Med Biol Soc 2019; 2018:6010-6013. [PMID: 30441706 DOI: 10.1109/embc.2018.8513619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Electroencephalogram (EEG) is a common tool in sleep medicine, but it is often compromised by non-neural artifacts. Excluding visually identified artifacts is time-consuming and removes relevant EEG information. Blind source separation (BSS) techniques, on the other hand, are capable of separating "brain" from "artifact source components". Existing algorithms for automated component labeling require either a priori morphological information or adaptation to individual recordings. We present a method for the automated identification of artifact components based on their autocorrelation and spectral properties. It requires no tuning for individual recordings. The method was tested on 100 one-minute EEG segments during rapid eye movement sleep. EEG source components were estimated by second order blind source identification and, as reference, manually labeled as "brain" or "artifact component". The algorithm identified electro-cardiogram components by autocorrelation peaks between 0.5-1.5 seconds and -oculogram components by linear discriminant analysis of spectral band-power. Using 5-fold cross-validation, we observed 97% accuracy (95% sensitivity, 98% specificity), as well as minimized correlation of artifacts and the EEG. The approach has demonstrated its potential as promising tool for a broad range of sleep medical applications.
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Didriksen M, Thørner LW, Erikstrup C, Pedersen OB, Paarup HM, Petersen M, Hansen TF, Banasik K, Nielsen KR, Hjalgrim H, Jennum PJ, Sørensen E, Burgdorf KS, Ullum H. Self-reported restless legs syndrome and involuntary leg movements during sleep are associated with symptoms of attention deficit hyperactivity disorder. Sleep Med 2019; 57:115-121. [DOI: 10.1016/j.sleep.2019.01.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/05/2018] [Accepted: 01/08/2019] [Indexed: 12/12/2022]
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Olesen1 AN, Thybo J, Chambon S, Thorey V, Jennum PJ, Sorensen HB, Mignot E. 0318 Towards A Deep Learning-based Joint Detection Model For Nocturnal Polysomnogram Events. Sleep 2019. [DOI: 10.1093/sleep/zsz067.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander N Olesen1
- Center for Sleep Sciences and Medicine, Stanford University, Stanford, CA, USA
- Danish Center for Sleep Medicine, Rigshospitalet, Glostrup, Denmark
| | - Jakob Thybo
- Department of Electrical Engineering, Technical University of Denmark, Kgs Lyngby, Denmark
- Center for Sleep Sciences and Medicine, Stanford University, Stanford, CA, USA
| | - Stanislas Chambon
- Center for Sleep Sciences and Medicine, Stanford University, Stanford, CA, USA
- Research & Algorithms Team, Dreem, Paris, France
- LTCI Télécom ParisTech, Université Paris-Saclay, Paris, France
| | | | - Poul J Jennum
- Danish Center for Sleep Medicine, Rigshospitalet, Glostrup, Denmark
| | - Helge B Sorensen
- Department of Electrical Engineering, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Emmanuel Mignot
- Center for Sleep Sciences and Medicine, Stanford University, Stanford, CA, USA
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Olsen M, Schneider LD, Cheung J, Peppard PE, Jennum PJ, Mignot E, Sorensen HBD. Automatic, electrocardiographic-based detection of autonomic arousals and their association with cortical arousals, leg movements, and respiratory events in sleep. Sleep 2019; 41:4796910. [PMID: 29329416 DOI: 10.1093/sleep/zsy006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Study Objectives The current definition of sleep arousals neglects to address the diversity of arousals and their systemic cohesion. Autonomic arousals (AA) are autonomic activations often associated with cortical arousals (CA), but they may also occur in relation to a respiratory event, a leg movement event or spontaneously, without any other physiological associations. AA should be acknowledged as essential events to understand and explore the systemic implications of arousals. Methods We developed an automatic AA detection algorithm based on intelligent feature selection and advanced machine learning using the electrocardiogram. The model was trained and tested with respect to CA systematically scored in 258 (181 training size/77 test size) polysomnographic recordings from the Wisconsin Sleep Cohort. Results A precision value of 0.72 and a sensitivity of 0.63 were achieved when evaluated with respect to CA. Further analysis indicated that 81% of the non-CA-associated AAs were associated with leg movement (38%) or respiratory (43%) events. Conclusions The presented algorithm shows good performance when considering that more than 80% of the false positives (FP) found by the detection algorithm appeared in relation to either leg movement or respiratory events. This indicates that most FP constitute autonomic activations that are indistinguishable from those with cortical cohesion. The proposed algorithm provides an automatic system trained in a clinical environment, which can be utilized to analyze the systemic and clinical impacts of arousals.
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Affiliation(s)
- Mads Olsen
- Department of Electrical Engineering, Biomedical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Logan Douglas Schneider
- Department of Psychiatry and Behavioral Medicine, Stanford University Center for Sleep Sciences and Medicine, Stanford University, CA
| | - Joseph Cheung
- Department of Psychiatry and Behavioral Medicine, Stanford University Center for Sleep Sciences and Medicine, Stanford University, CA
| | - Paul E Peppard
- School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Poul J Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, Glostrup, Denmark
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Medicine, Stanford University Center for Sleep Sciences and Medicine, Stanford University, CA
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Jensen MLF, Vestergaard MB, Tønnesen P, Larsson HBW, Jennum PJ. Cerebral blood flow, oxygen metabolism, and lactate during hypoxia in patients with obstructive sleep apnea. Sleep 2019; 41:4788814. [PMID: 29309697 DOI: 10.1093/sleep/zsy001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Study Objectives Obstructive sleep apnea (OSA) is associated with increased risk of stroke but the underlying mechanism is poorly understood. We suspect that the normal cerebrovascular response to hypoxia is disturbed in patients with OSA. Methods Global cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), and lactate concentration during hypoxia were measured in patients with OSA and matched controls. Twenty-eight patients (82.1% males, mean age 52.3 ± 10.0 years) with moderate-to-severe OSA assessed by partial polysomnography were examined and compared with 19 controls (73.7% males, mean age 51.8 ± 10.1 years). Patients and controls underwent magnetic resonance imaging (MRI) during 35 min of normoxia followed by 35 min inhaling hypoxic air (10%-12% O2). After 3 months of continuous positive airway pressure (CPAP) treatment, 22 patients were rescanned. Results During hypoxia, CBF significantly increased with decreasing arterial blood oxygen concentration (4.53 mL (blood)/100 g/min per -1 mmol(O2)/L, p < 0.001) in the control group, but was unchanged (0.89 mL (blood)/100 g/min per -1 mmol(O2)/L, p = 0.289) in the patient group before CPAP treatment. The CBF response to hypoxia was significantly weaker in patients than in controls (p = 0.003). After 3 months of CPAP treatment the CBF response normalized, showing a significant increase during hypoxia (5.15 mL (blood)/100 g/min per -1 mmol(O2)/L, p < 0.001). There was no difference in CMRO2 or cerebral lactate concentration between patients and controls, and no effect of CPAP treatment. Conclusions Patients with OSA exhibit reduced CBF in response to hypoxia. CPAP treatment normalized these patterns.
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Affiliation(s)
- M L F Jensen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - M B Vestergaard
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Glostrup, Denmark
| | - P Tønnesen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - H B W Larsson
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Glostrup, Denmark
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
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Waser M, Benke T, Dal‐Bianco P, Garn H, Mosbacher JA, Ransmayr G, Schmidt R, Seiler S, Sorensen HBD, Jennum PJ. Neuroimaging markers of global cognition in early Alzheimer's disease: A magnetic resonance imaging-electroencephalography study. Brain Behav 2019; 9:e01197. [PMID: 30592179 PMCID: PMC6346656 DOI: 10.1002/brb3.1197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 11/26/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) and electroencephalography (EEG) are a promising means to an objectified assessment of cognitive impairment in Alzheimer's disease (AD). Individually, however, these modalities tend to lack precision in both AD diagnosis and AD staging. A joint MRI-EEG approach that combines structural with functional information has the potential to overcome these limitations. MATERIALS AND METHODS This cross-sectional study systematically investigated the link between MRI and EEG markers and the global cognitive status in early AD. We hypothesized that the joint modalities would identify cognitive deficits with higher accuracy than the individual modalities. In a cohort of 111 AD patients, we combined MRI measures of cortical thickness and regional brain volume with EEG measures of rhythmic activity, information processing and functional coupling in a generalized multiple regression model. Machine learning classification was used to evaluate the markers' utility in accurately separating the subjects according to their cognitive score. RESULTS We found that joint measures of temporal volume, cortical thickness, and EEG slowing were well associated with the cognitive status and explained 38.2% of ifs variation. The inclusion of the covariates age, sex, and education considerably improved the model. The joint markers separated the subjects with an accuracy of 84.7%, which was considerably higher than by using individual modalities. CONCLUSIONS These results suggest that including joint MRI-EEG markers may be beneficial in the diagnostic workup, thus allowing for adequate treatment. Further studies in larger populations, with a longitudinal design and validated against functional-metabolic imaging are warranted to confirm the results.
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Affiliation(s)
- Markus Waser
- Biomedical EngineeringDepartment of Electrical EngineeringTechnical University of DenmarkLyngbyDenmark
- Danish Center for Sleep MedicineDepartment of Clinical NeurophysiologyRigshospitalet GlostrupGlostrupDenmark
- AIT Austrian Institute of Technology GmbHCenter for Digital Safety & SecuritySensing and Vision SolutionsViennaAustria
| | - Thomas Benke
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Peter Dal‐Bianco
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Heinrich Garn
- AIT Austrian Institute of Technology GmbHCenter for Digital Safety & SecuritySensing and Vision SolutionsViennaAustria
| | | | - Gerhard Ransmayr
- Clinic for Neurology IIKepler University HospitalMed Campus IIILinzAustria
| | | | - Stephan Seiler
- Department of NeurologyMedical University of GrazGrazAustria
| | - Helge B. D. Sorensen
- Biomedical EngineeringDepartment of Electrical EngineeringTechnical University of DenmarkLyngbyDenmark
| | - Poul J. Jennum
- Danish Center for Sleep MedicineDepartment of Clinical NeurophysiologyRigshospitalet GlostrupGlostrupDenmark
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West AS, Sennels HP, Simonsen SA, Schønsted M, Zielinski AH, Hansen NC, Jennum PJ, Sander B, Wolfram F, Iversen HK. The Effects of Naturalistic Light on Diurnal Plasma Melatonin and Serum Cortisol Levels in Stroke Patients during Admission for Rehabilitation: A Randomized Controlled Trial. Int J Med Sci 2019; 16:125-134. [PMID: 30662336 PMCID: PMC6332482 DOI: 10.7150/ijms.28863] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Stroke patients admitted for rehabilitation often lack sufficient daytime blue light exposure due to the absence of natural light and are often exposed to light at unnatural time points. We hypothesized that artificial light imitating daylight, termed naturalistic light, would stabilize the circadian rhythm of plasma melatonin and serum cortisol levels among long-term hospitalized stroke patients. Methods: A quasi-randomized controlled trial. Stroke patients in need of rehabilitation were randomized between May 1, 2014, and June 1, 2015 to either a rehabilitation unit equipped entirely with always on naturalistic lighting (IU), or to a rehabilitation unit with standard indoor lighting (CU). At both inclusion and discharge after a hospital stay of at least 2 weeks, plasma melatonin and serum cortisol levels were measured every 4 hours over a 24-hour period. Circadian rhythm was estimated using cosinor analysis, and variance between time-points. Results: A total of 43 were able to participate in the blood collection. Normal diurnal rhythm of melatonin was disrupted at both inclusion and discharge. In the IU group, melatonin plasma levels were increased at discharge compared to inclusion (n = 23; median diff, 2.9; IQR: -1.0 to 9.9, p = 0.030) and rhythmicity evolved (n = 23; p = 0.007). In the CU group, melatonin plasma levels were similar between discharge and inclusion and no rhythmicity evolved. Overall, both patient groups showed normal cortisol diurnal rhythms at both inclusion and discharge. Conclusions: This study is the first to demonstrate elevated melatonin plasma levels and evolved rhythmicity due to stimulation with naturalistic light.
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Affiliation(s)
- Anders S West
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Henriette P Sennels
- Department of Clinical Biochemistry, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen
| | - Sofie A Simonsen
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Marie Schønsted
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Alexander H Zielinski
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Niklas C Hansen
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Neurophysiology Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
| | - Birgit Sander
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital
| | - Frauke Wolfram
- Department of diagnostic, Radiologic clinic, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen
| | - Helle K Iversen
- Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen
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Waser M, Garn H, Benke T, Dal-Bianco P, Ransmayr G, Schmidt R, Jennum PJ, Sorensen HBD. A flexible method for the automated offline-detection of artifacts in multi-channel electroencephalogram recordings. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2017:3793-3796. [PMID: 29060724 DOI: 10.1109/embc.2017.8037683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Electroencephalogram (EEG) signal quality is often compromised by artifacts that corrupt quantitative EEG measurements used in clinical applications and EEG-related studies. Techniques such as filtering, regression analysis and blind source separation are often used to remove these artifacts. However, these preprocessing steps do not allow for complete artifact correction. We propose a method for the automated offline-detection of remaining artifacts after preprocessing in multi-channel EEG recordings. In contrast to existing methods it requires neither adaptive parameters varying between recordings nor a topography template. It is suited for short EEG segments and is flexible with regard to target applications. The algorithm was developed and tested on 60 clinical EEG samples of 20 seconds each that were recorded both in resting state and during cognitive activation to gain a realistic artifact set. Five EEG features were used to quantify temporal and spatial signal variations. Two distance measures for the single-channel and multi-channel variations of these features were defined. The global thresholds were determined by three-fold cross-validation and Youden's J statistic in conjunction with receiver operating characteristics (ROC curves). We observed high sensitivity of 95.5%±4.8 and specificity of 88.8%±2.1. The method has thus shown great potential and is promising as a possible tool for both EEG-based clinical applications and EEG-related research.
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21
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Olesen AN, Peppard PE, Sorensen HB, Jennum PJ, Mignot E. 0316 End-to-End Deep Learning Model For Automatic Sleep Staging Using Raw PSG Waveforms. Sleep 2018. [DOI: 10.1093/sleep/zsy061.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A N Olesen
- Department of Electrical Engineering, Technical University of Denmark, Kgs Lyngby, DENMARK
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Stanford, CA
- Danish Center for Sleep Medicine, Rigshospitalet, Glostrup, DENMARK
| | - P E Peppard
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - H B Sorensen
- Department of Electrical Engineering, Technical University of Denmark, Kgs Lyngby, DENMARK
| | - P J Jennum
- Danish Center for Sleep Medicine, Rigshospitalet, Glostrup, DENMARK
| | - E Mignot
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Stanford, CA
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22
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Brink-Kjær A, Olesen AN, Jespersen CA, Peppard PE, Jennum PJ, Sørensen HB, Mignot E. 0142 Automatic Detection of Cortical Arousals in Sleep using Bi-direction LSTM Networks. Sleep 2018. [DOI: 10.1093/sleep/zsy061.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Brink-Kjær
- Stanford University Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Medicine, Stanford University, Palo Alto, CA
- Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, DENMARK
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, DENMARK
| | - A N Olesen
- Stanford University Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Medicine, Stanford University, Palo Alto, CA
- Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, DENMARK
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, DENMARK
| | - C A Jespersen
- Stanford University Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Medicine, Stanford University, Palo Alto, CA
- Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, DENMARK
| | - P E Peppard
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - P J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, DENMARK
| | - H B Sørensen
- Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, DENMARK
| | - E Mignot
- Stanford University Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Medicine, Stanford University, Palo Alto, CA
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Jacobsen KP, Olesen AN, Trap L, Peppard PE, Sorensen HB, Jennum PJ, Mignot E. 0328 Automatic Detection of Respiratory Events During Sleep Using Bidirectional LSTM Networks. Sleep 2018. [DOI: 10.1093/sleep/zsy061.327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K P Jacobsen
- Stanford University Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Medicine, Stanford University, Palo Alto, CA
- Department of Electrical Engineering, Technical University of Denmark, Kgs. Lyngby, DENMARK
| | - A N Olesen
- Stanford University Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Medicine, Stanford University, Palo Alto, CA
- Department of Electrical Engineering, Technical University of Denmark, Kgs. Lyngby, DENMARK
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, DENMARK
| | - L Trap
- Department of Electrical Engineering, Technical University of Denmark, Kgs. Lyngby, DENMARK
- Stanford University Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Medicine, Stanford University, Palo Alto, CA
| | - P E Peppard
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - H B Sorensen
- Department of Electrical Engineering, Technical University of Denmark, Kgs. Lyngby, DENMARK
| | - P J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, DENMARK
| | - E Mignot
- Stanford University Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Medicine, Stanford University, Palo Alto, CA
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Carvelli L, Neergard Olesen A, Leary EB, Moore H, Schneider LD, Peppard PE, Jennum PJ, Sørensen HB, Mignot E. 0323 Design of a Deep Learning Based Algorithm forAutomatic Detection of Leg Movements During Sleep. Sleep 2018. [DOI: 10.1093/sleep/zsy061.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Carvelli
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - A Neergard Olesen
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - E B Leary
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - H Moore
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - L D Schneider
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - P E Peppard
- University of Wisconsin-Madison, Madison, WI
| | - P J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, DENMARK
| | - H B Sørensen
- Department of Electrical Engineering, Technical University of Denmark, Kgs. Lyngby, DENMARK
| | - E Mignot
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
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25
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Didriksen M, Allen RP, Burchell BJ, Thørner LW, Rigas AS, Di Angelantonio E, Nielsen MH, Jennum PJ, Werge T, Erikstrup C, Pedersen OB, Nielsen K, Bruun MT, Burgdorf KS, Sørensen E, Ullum H. Restless legs syndrome is associated with major comorbidities in a population of Danish blood donors. Sleep Med 2018; 45:124-131. [PMID: 29680420 DOI: 10.1016/j.sleep.2018.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/15/2017] [Accepted: 02/23/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Restless Legs Syndrome (RLS) is characterized by uncomfortable nocturnal sensations in the legs making sedentary activities and sleep difficult, and is thus linked with psychosocial distress. Due to the symptomatology and neurobiology of RLS (disrupting brain iron and dopamine) it is likely that RLS associates with poorer health-related quality of life (HRQL) and depressive disorder. The objective of this study was to investigate the RLS-HRQL and the RLS-depressive disorder links in a generally healthy population that is not biased by medications. METHODS Complete data, including the Cambridge-Hopkins RLS questionnaire, the 12-item short-form standardized health survey (SF-12), the Major Depression Inventory (MDI), body mass index, smoking status, alcohol consumption, and education were available for 24,707 participants enrolled in the Danish Blood Donor Study from May 1, 2015 to February 1, 2017. Information on quality of sleep was available for all RLS cases. T-tests and multivariable logistic regression models were applied to examine the associations of RLS and MDI scores, and the physical and mental component scores (PCS and MCS) of SF-12, respectively. Analyses were conducted separately for men and women. RESULTS RLS associated with poorer MCS and poorer PCS. Moreover, Participants with RLS were more likely to classify with depressive disorder. Poor quality of sleep was associated with depressive disorder and poorer MCS among RLS cases, and with poorer PCS in female RLS cases. CONCLUSION Thus, we demonstrated that RLS is associated with a significantly lower HRQL and a higher prevalence of depressive disorder among otherwise healthy individuals.
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Affiliation(s)
- Maria Didriksen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Richard P Allen
- Department of Neurology, John Hopkins University School of Medicine, Baltimore, USA
| | - Brendan J Burchell
- Faculty of Human, Social and Political Sciences, University of Cambridge, Cambridge, UK
| | - Lise W Thørner
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas S Rigas
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; National Institute for Health Research, Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, UK
| | - Maria H Nielsen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Poul J Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Glostrup, Denmark; Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Mental Health Services, Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole B Pedersen
- Department of Clinical Immunology, Nastved Sygehus, Nastved, Denmark
| | - Kaspar Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Mie T Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Kristoffer S Burgdorf
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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26
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Joustra SD, Gu C, Rohling JHT, Pickering L, Klose M, Hu K, Scheer FA, Feldt-Rasmussen U, Jennum PJ, Pereira AM, Biermasz NR, Meijer JH. Decrease in scale invariance of activity fluctuations with aging and in patients with suprasellar tumors. Chronobiol Int 2017; 35:368-377. [PMID: 29182371 PMCID: PMC5862770 DOI: 10.1080/07420528.2017.1407779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Motor activity in healthy young humans displays intrinsic fluctuations that are scale-invariant over a wide range of time scales (from minutes to hours). Human postmortem and animal lesion studies showed that the intact function of the suprachiasmatic nucleus (SCN) is required to maintain such scale-invariant patterns. We therefore hypothesized that scale invariance is degraded in patients treated for suprasellar tumors that compress the SCN. To test the hypothesis, we investigated 68 patients with nonfunctioning pituitary macroadenoma and 22 patients with craniopharyngioma, as well as 72 age-matched healthy controls (age range 21.0–70.6 years). Spontaneous wrist locomotor activity was measured for 7 days with actigraphy, and detrended fluctuation analysis was applied to assess correlations over a range of time scales from minutes to 24 h. For all the subjects, complex scale-invariant correlations were only present for time scales smaller than 1.5 h, and became more random at time scales 1.5–10 h. Patients with suprasellar tumors showed a larger decrease in correlations at 1.5–10 h as compared to healthy controls. Within healthy subject, gender and age >33 year were associated with attenuated scale invariance. Conversely, activity patterns at time scales between 10 and 24 h were significantly more regular than all other time scales, and this was mostly associated with age. In conclusion, scale invariance is degraded in healthy subjects at the ages of >33 year as characterized by attenuation of correlations at time scales 1.5–10 h. In addition, scale invariance was more degraded in patients with suprasellar tumors as compared to healthy subjects.
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Affiliation(s)
- S D Joustra
- a Center for Endocrine Tumors Leiden, Department of Medicine, Division of Endocrinology , Leiden University Medical Center , Leiden , The Netherlands
| | - C Gu
- b Department of Molecular Cell Biology , Laboratory for Neurophysiology, Leiden University Medical Center , Leiden , The Netherlands.,c Business School , University of Shanghai for Science and Technology , Shanghai , China
| | - J H T Rohling
- b Department of Molecular Cell Biology , Laboratory for Neurophysiology, Leiden University Medical Center , Leiden , The Netherlands
| | - L Pickering
- d Department of Medical Endocrinology , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark.,e Danish Center for Sleep Medicine , Neurophysiologic Clinic, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - M Klose
- d Department of Medical Endocrinology , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - K Hu
- f Division of Sleep and Circadian Disorders , Brigham and Women's Hospital , Boston , MA , USA.,g Division of Sleep Medicine , Harvard Medical School , Boston , MA , USA
| | - F A Scheer
- f Division of Sleep and Circadian Disorders , Brigham and Women's Hospital , Boston , MA , USA.,g Division of Sleep Medicine , Harvard Medical School , Boston , MA , USA
| | - U Feldt-Rasmussen
- d Department of Medical Endocrinology , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - P J Jennum
- e Danish Center for Sleep Medicine , Neurophysiologic Clinic, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - A M Pereira
- a Center for Endocrine Tumors Leiden, Department of Medicine, Division of Endocrinology , Leiden University Medical Center , Leiden , The Netherlands
| | - N R Biermasz
- a Center for Endocrine Tumors Leiden, Department of Medicine, Division of Endocrinology , Leiden University Medical Center , Leiden , The Netherlands
| | - J H Meijer
- b Department of Molecular Cell Biology , Laboratory for Neurophysiology, Leiden University Medical Center , Leiden , The Netherlands
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27
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Olesen AN, Christensen JAE, Sorensen HBD, Jennum PJ. A Noise-Assisted Data Analysis Method for Automatic EOG-Based Sleep Stage Classification Using Ensemble Learning. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:3769-3772. [PMID: 28269109 DOI: 10.1109/embc.2016.7591548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Reducing the number of recording modalities for sleep staging research can benefit both researchers and patients, under the condition that they provide as accurate results as conventional systems. This paper investigates the possibility of exploiting the multisource nature of the electrooculography (EOG) signals by presenting a method for automatic sleep staging using the complete ensemble empirical mode decomposition with adaptive noise algorithm, and a random forest classifier. It achieves a high overall accuracy of 82% and a Cohen's kappa of 0.74 indicating substantial agreement between automatic and manual scoring.
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28
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Schneider LD, Koch H, Finn LA, Leary EB, Peppard PE, Hagen EW, Sorensen HB, Jennum PJ, Mignot EJ. 0505 SLEEP APNEA BREATHING DISTURBANCES ARE ASSOCIATED WITH OBJECTIVE SLEEPINESS INDEPENDENT OF HYPOXIA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Laub RR, Tønnesen P, Jennum PJ. A Sleep Position Trainer for positional sleep apnea: a randomized, controlled trial. J Sleep Res 2017; 26:641-650. [PMID: 28370716 DOI: 10.1111/jsr.12530] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/19/2017] [Indexed: 11/30/2022]
Abstract
We tested the effect of the Sleep Position Trainer, a vibrational device, for positional sleep apnea in an open, randomized controlled trial with 101 patients, where 52 patients were allocated to Sleep Position Trainer and 49 patients to a non-treatment control group for 2 months (Part 1). All patients were then followed as a cohort for a period of 6 months with use of the Sleep Position Trainer (Part 2). The participants were assessed with polygraphy at entry, and after 2 and 6 months. The mean apnea-hypopnea index supine was 35 per h (SD, 18) in the Sleep Position Trainer group and 38 per h (SD, 15) in the control group at entry. In a per protocol analysis, the mean total apnea-hypopnea index at entry and after 2 months in the Sleep Position Trainer group was 18 per h (SD, 10) and 10 per h (SD, 9; P < 0.001) versus 20 per h (SD, 9) and 18 per h (SD, 10; NS) in the control group. The mean supine sleep time decreased from 47% (SD, 22) to 17% (SD, 18; P < 0.001) in the Sleep Position Trainer group after 2 months. In the control group, the mean supine sleep time was 48% (SD, 20) at entry and 39% (SD, 21; NS) after 2 months. The positive effect of Sleep Position Trainer was maintained in all patients treated with Sleep Position Trainer after 6 months. Daytime sleepiness improved after 6 months. Compliance with the Sleep Position Trainer device during the first 2 months, defined as use of Sleep Position Trainer >4 h per night for all weekdays, was 75.5% (SD 21.2). The discontinuation rate was 28.8 and 49.4% after 2 and 6 months, respectively.
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Affiliation(s)
- Rasmus R Laub
- Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Philip Tønnesen
- Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Poul J Jennum
- Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Rigshospitalet-Glostrup, Copenhagen, Denmark
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Schrölkamp M, Jennum PJ, Gammeltoft S, Holm A, Kornum BR, Knudsen S. Normal Morning Melanin-Concentrating Hormone Levels and No Association with Rapid Eye Movement or Non-Rapid Eye Movement Sleep Parameters in Narcolepsy Type 1 and Type 2. J Clin Sleep Med 2017; 13:235-243. [PMID: 27855741 DOI: 10.5664/jcsm.6454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/03/2016] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES Other than hypocretin-1 (HCRT-1) deficiency in narcolepsy type 1 (NT1), the neurochemical imbalance of NT1 and narcolepsy type 2 (NT2) with normal HCRT-1 levels is largely unknown. The neuropeptide melanin-concentrating hormone (MCH) is mainly secreted during sleep and is involved in rapid eye movement (REM) and non-rapid eye movement (NREM) sleep regulation. Hypocretin neurons reciprocally interact with MCH neurons. We hypothesized that altered MCH secretion contributes to the symptoms and sleep abnormalities of narcolepsy and that this is reflected in morning cerebrospinal fluid (CSF) MCH levels, in contrast to previously reported normal evening/afternoon levels. METHODS Lumbar CSF and plasma were collected from 07:00 to 10:00 from 57 patients with narcolepsy (subtypes: 47 NT1; 10 NT2) diagnosed according to International Classification of Sleep Disorders, Third Edition (ICSD-3) and 20 healthy controls. HCRT-1 and MCH levels were quantified by radioimmunoassay and correlated with clinical symptoms, polysomnography (PSG), and Multiple Sleep Latency Test (MSLT) parameters. RESULTS CSF and plasma MCH levels were not significantly different between narcolepsy patients regardless of ICSD-3 subtype, HCRT-1 levels, or compared to controls. CSF MCH and HCRT-1 levels were not significantly correlated. Multivariate regression models of CSF MCH levels, age, sex, and body mass index predicting clinical, PSG, and MSLT parameters did not reveal any significant associations to CSF MCH levels. CONCLUSIONS Our study shows that MCH levels in CSF collected in the morning are normal in narcolepsy and not associated with the clinical symptoms, REM sleep abnormalities, nor number of muscle movements during REM or NREM sleep of the patients. We conclude that morning lumbar CSF MCH measurement is not an informative diagnostic marker for narcolepsy.
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Affiliation(s)
- Maren Schrölkamp
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark.,FU-Berlin, Faculty Biology, Chemistry, Pharmacy, Takustr, Berlin, Germany
| | - Poul J Jennum
- Danish Center for Sleep Medicine, University of Copenhagen, Rigshospitalet, Glostrup, Denmark
| | - Steen Gammeltoft
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark
| | - Anja Holm
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark
| | - Birgitte R Kornum
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark
| | - Stine Knudsen
- Danish Center for Sleep Medicine, University of Copenhagen, Rigshospitalet, Glostrup, Denmark.,Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Oslo University Hospital, Ullevål, Norway
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31
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Abstract
Narcolepsy is a chronic sleep disorder that has a typical onset in adolescence and is characterized by excessive daytime sleepiness, which can have severe consequences for the patient. Problems faced by patients with narcolepsy include social stigma associated with this disease, difficulties in obtaining an education and keeping a job, a reduced quality of life and socioeconomic consequences. Two subtypes of narcolepsy have been described (narcolepsy type 1 and narcolepsy type 2), both of which have similar clinical profiles, except for the presence of cataplexy, which occurs only in patients with narcolepsy type 1. The pathogenesis of narcolepsy type 1 is hypothesized to be the autoimmune destruction of the hypocretin-producing neurons in the hypothalamus; this hypothesis is supported by immune-related genetic and environmental factors associated with the disease. However, direct evidence in support of the autoimmune hypothesis is currently unavailable. Diagnosis of narcolepsy encompasses clinical, electrophysiological and biological evaluations, but simpler and faster procedures are needed. Several medications are available for the symptomatic treatment of narcolepsy, all of which have quite good efficacy and safety profiles. However, to date, no treatment hinders or slows disease development. Improved diagnostic tools and increased understanding of the pathogenesis of narcolepsy type 1 are needed and might lead to therapeutic or even preventative interventions.
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Affiliation(s)
- Birgitte R Kornum
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Forskerparken, Nordre Ringvej 69, 2600 Glostrup, Denmark.,Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Stine Knudsen
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Hanna M Ollila
- Department of Psychiatry and Behavioral Sciences, Center for Sleep Sciences, Stanford University, Stanford, California, USA
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, AUSL di Bologna, Bologna, Italy
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Yves Dauvilliers
- Sleep Unit, Narcolepsy Reference Center, Department of Neurology, Gui de Chauliac Hospital, INSERM 1061, Montpellier, France
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
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32
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Jennum PJ, Kornum BR, Issa NM, Gammeltoft S, Tommerup N, Morling N, Tümer Z, Knudsen S. Monozygotic twins discordant for narcolepsy type 1 and multiple sclerosis. Neurol Neuroimmunol Neuroinflamm 2016; 3:e249. [PMID: 27354986 PMCID: PMC4911794 DOI: 10.1212/nxi.0000000000000249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/06/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Poul J Jennum
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Birgitte R Kornum
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Nadia M Issa
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Steen Gammeltoft
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Niels Tommerup
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Niels Morling
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Zeynep Tümer
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Stine Knudsen
- Danish Center for Sleep Medicine (P.J.J., S.K.) and Molecular Sleep Laboratory, Department of Clinical Biochemistry (B.R.K., S.G.), University of Copenhagen, Rigshospitalet, Glostrup, Denmark; Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom) (S.K.), Oslo University Hospital, Ullevål, Norway; Department of Neurology (N.M.I.), University of Copenhagen, Hillerød Hospital; Department of Cellular and Molecular Medicine, Panum Institute (N.T.), and Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Science (N.M.), University of Copenhagen; Applied Human Molecular Genetics (Z.T.), Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
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Virring A, Lambek R, Thomsen PH, Møller LR, Jennum PJ. Disturbed sleep in attention-deficit hyperactivity disorder (ADHD) is not a question of psychiatric comorbidity or ADHD presentation. J Sleep Res 2016; 25:333-40. [DOI: 10.1111/jsr.12377] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Anne Virring
- Centre for Child and Adolescent Psychiatry; Aarhus University Hospital Risskov; Aarhus Denmark
| | - Rikke Lambek
- Department of Psychology and Behavioural Sciences; Aarhus University; Aarhus Denmark
| | - Per H. Thomsen
- Centre for Child and Adolescent Psychiatry; Aarhus University Hospital Risskov; Aarhus Denmark
| | - Lene R. Møller
- Centre for Child and Adolescent Psychiatry; Aarhus University Hospital Risskov; Aarhus Denmark
| | - Poul J. Jennum
- Rigshospitalet; Danish Center for Sleep Medicine; Department of Clinical Neurophysiology; University of Copenhagen; Copenhagen Denmark
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Barloese MCJ, Mehlsen J, Brinth L, Lundberg HIS, Jennum PJ, Jensen RH. Reduced Baroreflex Sensitivity in Cluster Headache Patients. Headache 2015; 55:815-24. [DOI: 10.1111/head.12586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Mads C. J. Barloese
- Department of Clinical Physiology and Nuclear Medicine; Frederiksberg and Bispebjerg Hospital; University of Copenhagen; Frederiksberg Denmark
- Danish Headache Center; Department of Neurology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
| | - Jesper Mehlsen
- Department of Clinical Physiology and Nuclear Medicine; Frederiksberg and Bispebjerg Hospital; University of Copenhagen; Frederiksberg Denmark
| | - Louise Brinth
- Department of Clinical Physiology and Nuclear Medicine; Frederiksberg and Bispebjerg Hospital; University of Copenhagen; Frederiksberg Denmark
| | - Helena I. S. Lundberg
- Department of Clinical Physiology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
| | - Poul J. Jennum
- Danish Center for Sleep Medicine; Department of Neurophysiology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
| | - Rigmor H. Jensen
- Danish Headache Center; Department of Neurology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
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35
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Christensen JAE, Nikolic M, Warby SC, Koch H, Zoetmulder M, Frandsen R, Moghadam KK, Sorensen HBD, Mignot E, Jennum PJ. Sleep spindle alterations in patients with Parkinson's disease. Front Hum Neurosci 2015; 9:233. [PMID: 25983685 PMCID: PMC4416460 DOI: 10.3389/fnhum.2015.00233] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 12/16/2014] [Accepted: 04/11/2015] [Indexed: 01/04/2023] Open
Abstract
The aim of this study was to identify changes of sleep spindles (SS) in the EEG of patients with Parkinson's disease (PD). Five sleep experts manually identified SS at a central scalp location (C3-A2) in 15 PD and 15 age- and sex-matched control subjects. Each SS was given a confidence score, and by using a group consensus rule, 901 SS were identified and characterized by their (1) duration, (2) oscillation frequency, (3) maximum peak-to-peak amplitude, (4) percent-to-peak amplitude, and (5) density. Between-group comparisons were made for all SS characteristics computed, and significant changes for PD patients vs. control subjects were found for duration, oscillation frequency, maximum peak-to-peak amplitude and density. Specifically, SS density was lower, duration was longer, oscillation frequency slower and maximum peak-to-peak amplitude higher in patients vs. controls. We also computed inter-expert reliability in SS scoring and found a significantly lower reliability in scoring definite SS in patients when compared to controls. How neurodegeneration in PD could influence SS characteristics is discussed. We also note that the SS morphological changes observed here may affect automatic detection of SS in patients with PD or other neurodegenerative disorders (NDDs).
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Affiliation(s)
- Julie A E Christensen
- Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark Kongens Lyngby, Denmark ; Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup University Hospital Glostrup, Denmark ; Stanford Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Sciences, Stanford University Palo Alto, CA, USA
| | - Miki Nikolic
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup University Hospital Glostrup, Denmark
| | - Simon C Warby
- Center for Advanced Research in Sleep Medicine, Sacré-Coeur Hospital of Montréal, University of Montréal Montréal, QC, Canada
| | - Henriette Koch
- Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark Kongens Lyngby, Denmark ; Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup University Hospital Glostrup, Denmark ; Stanford Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Sciences, Stanford University Palo Alto, CA, USA
| | - Marielle Zoetmulder
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup University Hospital Glostrup, Denmark ; Department of Neurology, Bispebjerg Hospital Copenhagen, Denmark
| | - Rune Frandsen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup University Hospital Glostrup, Denmark
| | - Keivan K Moghadam
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna Bologna, Italy
| | - Helge B D Sorensen
- Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark Kongens Lyngby, Denmark
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Psychiatry and Behavioral Sciences, Stanford University Palo Alto, CA, USA
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup University Hospital Glostrup, Denmark ; Center for Healthy Ageing, University of Copenhagen Copenhagen, Denmark
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Kern W, Madsbad S, Rye Jørgensen N, Rabøl R, Chu PL, Stender-Petersen K, Jennum PJ. Einfluss nächtlicher Hypoglykämien auf den Schlaf bei Menschen mit Typ 2 Diabetes. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549665] [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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Barloese MCJ, Jennum PJ, Lund NT, Jensen RH. Sleep in cluster headache - beyond a temporal rapid eye movement relationship? Eur J Neurol 2014; 22:656-e40. [PMID: 25557272 DOI: 10.1111/ene.12623] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/17/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Cluster headache (CH) is a primary headache disorder characterized by severe attacks of unilateral pain following a chronobiological pattern. There is a close connection with sleep as most attacks occur during sleep. Hypothalamic involvement and a particular association with rapid eye movement (REM) sleep have been suggested. Sleep in a large, well-characterized population of CH patients was investigated. METHODS Polysomnography (PSG) was performed on two nights in 40 CH patients during active bout and one night in 25 age, sex and body mass index matched controls in hospital. Macrostructure and other features of sleep were analyzed and related to phenotype. Clinical headache characterization was obtained by semi-structured interview. RESULTS Ninety-nine nights of PSG were analyzed. Findings included a reduced percentage of REM sleep (17.3% vs. 23.0%, P = 0.0037), longer REM latency (2.0 vs. 1.2 h, P = 0.0012) and fewer arousals (7.34 vs. 14.1, P = 0.003) in CH patients. There was no difference in prevalence of sleep apnea between patients (38%) and matched controls (32%, P = 0.64) although the apnea index in patients was numerically higher (mean apnea-hypopnea index 10.75 vs. 4.93). No temporal association between nocturnal attacks (n = 45) and particular sleep stages was observed. CONCLUSIONS To date, this is the largest study of sleep in CH. It is demonstrated that REM sleep is affected which is in line with our current understanding of CH and hypothalamic involvement in the regulation of this sleep stage. Further, fewer arousals were found in CH patients but no association between apnea events or specific sleep stages. The findings support a central role of the hypothalamus and arousal systems in CH.
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Affiliation(s)
- M C J Barloese
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
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38
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Zoetmulder M, Biernat HB, Nikolic M, Korbo L, Friberg L, Jennum PJ. Prepulse inhibition is associated with attention, processing speed, and 123I-FP-CIT SPECT in Parkinson's disease. J Parkinsons Dis 2014; 4:77-87. [PMID: 24366928 DOI: 10.3233/jpd-130307] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prepulse inhibition is a measure of sensorimotor gating, which reflects the ability to filter or 'gate' irrelevant information. Prepulse inhibition is dramatically altered in basal ganglia disorders associated with dysfunction in the midbrain dopaminergic system, and corresponding cognitive information processing deficits such as slowed processing speed. Parkinson's disease is characterised by the degeneration of the midbrain dopaminergic system and is associated with cognitive dysfunction, including slowed information processing. Although sensorimotor processes in Parkinson's disease have been extensively studied in relation to motor function, less is known about the potential role of sensorimotor processes in cognitive function. OBJECTIVE We investigated the relationship between prepulse inhibition, cognition and nigrostriatal dysfunction, as measured with 123I-FP-CIT-SPECT scanning, in patients with Parkinson's disease. METHODS 38 Parkinson patients were assessed with prepulse inhibition, neuropsychological tests, and neurological investigation. A subset of these patients underwent 123I-FP-CIT-SPECT scanning. RESULTS Patients with a higher level of prepulse inhibition performed better on cognitive measures tapping attention and processing speed than patients with a lower level of prepulse inhibition. Furthermore, there were significant correlations between prepulse inhibition and 123I-FP-CIT uptake in the striatum. CONCLUSIONS Our results suggest that the level of prepulse inhibition is related to the efficiency of information processing in Parkinson's disease, and to the density of dopamine transporters in the striatum.
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Affiliation(s)
- Marielle Zoetmulder
- Department of Neurology, Bispebjerg University Hospital, Copenhagen NV, Denmark Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, Glostrup, Denmark
| | - Heidi B Biernat
- Department of Neurology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - Miki Nikolic
- Department of Clinical Neurophysiology, Glostrup Hospital, Glostrup, Denmark
| | - Lise Korbo
- Department of Neurology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - Lars Friberg
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, Glostrup, Denmark
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Knudsen S, Biering-Sørensen B, Kornum BR, Petersen ER, Ibsen JD, Gammeltoft S, Mignot E, Jennum PJ. Early IVIg treatment has no effect on post-H1N1 narcolepsy phenotype or hypocretin deficiency. Neurology 2012; 79:102-3. [PMID: 22722630 DOI: 10.1212/wnl.0b013e31825dce03] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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)
- Stine Knudsen
- Danish Center for Sleep Medicine, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark.
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Knudsen S, Jennum PJ, Alving J, Sheikh SP, Gammeltoft S. Validation of the ICSD-2 criteria for CSF hypocretin-1 measurements in the diagnosis of narcolepsy in the Danish population. Sleep 2010; 33:169-76. [PMID: 20175400 DOI: 10.1093/sleep/33.2.169] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES The International Classification of Sleep Disorders (ICSD-2) criteria for low CSF hypocretin-1 levels (CSF hcrt-1) still need validation as a diagnostic tool for narcolepsy in different populations because inter-assay variability and different definitions of hypocretin deficiency complicate direct comparisons of study results. DESIGN AND PARTICIPANTS Interviews, polysomnography, multiple sleep latency test, HLA-typing, and CSF hcrt-1 measurements in Danish patients with narcolepsy with cataplexy (NC) and narcolepsy without cataplexy (NwC), CSF hcrt-1 measurements in other hypersomnias, neurological and normal controls. Comparisons of hypocretin deficiency and frequency of HLA-DQB1*0602-positivity in the Danish and eligible NC and NwC populations (included via MEDLINE search), by (re)calculation of study results using the ICSD-2 criterion for low CSF hcrt-1 (< 30% of normal mean). MEASUREMENTS AND RESULTS In Danes, low CSF hcrt-1 was present in 40/46 NC, 3/14 NwC and 0/106 controls (P < 0.0001). Thirty-nine of 41 NC and 4/13 NwC patients were HLA-DQB1*0602-positive (P < 0.01). Hypocretin-deficient NC patients had higher frequency of cataplexy, shorter mean sleep latency, more sleep onset REM periods (P < 0.05) and more awakenings (NS) than did NC patients with normal CSF hcrt-1. Across populations, low CSF hcrt-1 and HLA-DQB1*0602-positivity characterized the majority of NC (80% to 100%, P = 0.53; 80% to 100%, P = 0.11) but a minority of NwC patients (11% to 29%, P = 0.75; 29% to 89%, P = 0.043). CONCLUSION The study provides evidence that hypocretin deficiency causes a more severe NC phenotype. The ICSD-2 criterion for low CSF hcrt-1 (< 30% of normal mean) is valid for diagnosing NC, but not NwC. HLA-typing should precede CSF hcrt-1 measurements because hypocretin deficiency is rare in HLA-DQB1*0602-negative patients.
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Affiliation(s)
- Stine Knudsen
- Danish Center for Sleep Medicine, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark.
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41
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Knudsen S, Jennum PJ, Korsholm K, Sheikh SP, Gammeltoft S, Frederiksen JL. Normal levels of cerebrospinal fluid hypocretin-1 and daytime sleepiness during attacks of relapsing-remitting multiple sclerosis and monosymptomatic optic neuritis. Mult Scler 2008; 14:734-8. [DOI: 10.1177/1352458508088939] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is emerging evidence that multiple sclerosis (MS), the hypothalamic sleep-wake regulating neuropeptide hypocretin-1 (hcrt-1) and the sleep disorder narcolepsy may be connected. Thus, the major pathophysiological component of narcolepsy is lack of hcrt-1. Dysfunction of the hypocretin system has been reported in MS case reports with attacks of hypothalamic lesions, undetectable cerebrospinal fluid (CSF) hcrt-1 and hypersomnia, but not found during remission in small samples. Finally, daytime sleepiness, the major symptom of narcolepsy, is reported in several MS populations, and there are case reports of co-existent narcolepsy and MS. However, it is unknown whether hcrt-1 and daytime sleepiness generally change during MS attacks. We therefore analyzed whether daytime sleepiness (using the Epworth Sleepiness Scale (ESS)) and CSF hcrt-1 levels differed between MS attack and remission, in 48 consecutively referred patients with relapsing–remitting MS (RRMS) or monosymptomatic optic neuritis (MON). Twenty-seven patients were in attack and 21 in remission. ESS was normal both during attacks (5.4 ± 3.0) and remission (5.8 ± 2.6), and mean CSF hcrt-1 was normal (456 ± 41 pg/ml). No statistically significant differences were found between attack and remission. MRI scans revealed no hypothalamic lesions. The results show that the hypocretin system is intact and sleepiness is not typical in RRMS and MON without hypothalamic lesions on MRI.
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Affiliation(s)
- S Knudsen
- Danish Center of Sleep Medicine, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark,
| | - PJ Jennum
- Glostrup Research Institute, Glostrup, Denmark
| | - K Korsholm
- Danish Research Centre for Magnetic Resonance, University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark
| | - SP Sheikh
- Department of Clinical Biochemistry, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
| | - S Gammeltoft
- Department of Biochemistry, Pharmacology and Genetics, University of Southern Denmark, Odense Hospital, Odense, Denmark
| | - JL Frederiksen
- Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
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42
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Jennum PJ. [Sleep medicine--from amusement to science. The Danish Society of Neurology]. Ugeskr Laeger 2006; 168:1234. [PMID: 16571325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Poul J Jennum
- Dansk Center for Søvnmedicin, Klinisk Neurofysiologisk Afdeling, Amtssygehuset i Glostrup, DK-2600 Glostrup.
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43
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Jennum PJ, Tønnesen P, Rasmussen N, Nørregaard O. [Sleep-related respiration disorders. Definition, prevalence, pathophysiology and consequences]. Ugeskr Laeger 2005; 167:2380-5. [PMID: 15987026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Poul J Jennum
- Amtssygehuset i Glostrup, Center for søvnforstyrrelser, Klinisk Neurofysiologisk Afdeling.
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44
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Jennum PJ, Tønnesen P, Rasmussen N, Nørregaard O. [Sleep-related respiration disorders. Diagnosis and treatment]. Ugeskr Laeger 2005; 167:2385-9. [PMID: 15987027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Poul J Jennum
- Amtssygehuset i Glostrup, Center for søvnforstyrrelser, Klinisk Neurofysiologisk Afdeling, Amtssygehuset i Gentofte.
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45
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Karlsborg M, Smed A, Jespersen HF, Stephensen SL, Cortsen ME, Jennum PJ, Herning GM, Korfitsen E, Werdelin LM. [Whiplash injury syndrome. A prospective study of 39 patients with whiplash injury]. Ugeskr Laeger 1998; 160:6211-5. [PMID: 9803871] [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: 02/09/2023]
Abstract
The acute symptoms after whiplash trauma can be explained by the neck sprain, but the pathogenesis of the "late whiplash syndrome" and the reasons why only some people have persistent symptoms more than six months are still unknown. Thirty-four consecutive cases of piskesmaeld injury were examined clinically three times; respectively within 14 days, after one month and finally seven months post-injury. In addition, MRI of the brain and the cervical spine, neuropsychological tests and motor evoked potentials (MEP) were done one month post-injury and repeated after six months, if abnormalities were found. We found the total recovery rate (asymptomatic patients) was 29% after seven months. All MEP examinations were normal. The correlation between MRI and the clinical findings was poor. Cognitive dysfunction as a symptom of brain injury was not found. Stress at the same time as the accident predicted more symptoms at follow-up. We conclude that long-lasting distress and poor outcome were more related to the occurrence of stressful life events than to clinical and paraclinical findings.
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46
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Jennum PJ, Sjøl A. [Cognitive symptoms in persons with snoring and sleep apnea. An epidemiologic study of 1.504 women and men aged 30-60 years. The Dan-MONICA II study]. Ugeskr Laeger 1995; 157:6252-6. [PMID: 7491717] [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: 01/25/2023]
Abstract
The objective of the study was to evaluate the relation between every-night (habitual) snoring, sleep apnoea and cognitive complaints (concentration and memory complaints) in an adult population-based sample. In the DAN-MONICA (MONItoring trends in CArdiovascular iseases) 1504 males and females aged 30, 40, 50 and 60 years were classified according to their snoring habits. Nocturnal respiration was measured in 748 participants. The following measures were regarded as potential confounders: age, gender, unintended sleepiness, insomnia, depression, hypnotic use, alcohol consumption by questionnaire, body mass index (BMI) and blood pressure. Concentration and memory problems were both related to depression, insomnia and unintended sleepiness. Snoring and sleep apnoea (defined as a respiratory distress index-RDI > or = 5) were associated with concentration problems and unintended sleepiness. The odds ratios (95% confidence intervals) between snoring, concentration and memory problems, calculated by logistic regression analysis after adjustments for the above confounders, were 1.90 (1.23-2.91, p < 0.01) and 1.38 (0.97-1.99, NS). For those with sleep apnoea, the odds ratios were 3.53 (1.42-8.73. p < 0.001) and 1.51 (0.81-2.14, NS) for concentration and memory problems, respectively. The main conclusion drawn from this study is that cognitive complaints show a high correlation to mood, insomnia and hypersomnia. Habitual snoring and sleep apnoea show a correlation to concentration problems, but not to memory problems. This suggests that part of the association between snoring, sleep apnoea and cognitive dysfunction is related to the presence of sleep disturbances and daytime sleepiness.
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Affiliation(s)
- P J Jennum
- medicinsk afdeling C, Amtssygehuset i Glostrup
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47
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Drewes AM, Andreasen A, Schrøder HD, Høgsaa BU, Jennum PJ. [Muscle biopsies in patients with fibromyalgia. A study based on light and electron microscopy]. Ugeskr Laeger 1994; 156:6844-7. [PMID: 7839500] [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: 01/27/2023]
Abstract
The value of muscle biopsy in fibromyalgia is still questioned. In this study we obtained 49 quadriceps biopsies from 20 patients and compared them blindly to 15 biopsies from five normal controls. Using light microscopy, histochemical and immunoenzymatic methods we found no definite evidence of muscle disease. Nevertheless, we subjected biopsies from nine of the patients and five other controls for further ultrastructural evaluations and demonstrated pathologic findings e.g. empty sleeves of basement membrane, many lipofuscin bodies and other degenerative changes. We conclude that ultrastructural evaluation cannot yet be used for diagnostic purposes, but the negative findings at light microscopy, including histochemical and immunoenzymatic techniques, might be of importance in evaluating difficult cases.
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Affiliation(s)
- A M Drewes
- Reumatologisk og ortopaedkirurgisk afdeling, Viborg Sygehus
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Jennum PJ, Andersen AR, Dam M, Fuglsang-Frederiksen A, a-Rogvi Hansen B, Lyon BB, Madsen FF. [Preoperative EEG in medically intractable epilepsy]. Ugeskr Laeger 1994; 156:1285-6, 1289-92. [PMID: 8009751] [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: 01/28/2023]
Abstract
The aim of the preoperative neurophysiological investigations is to identify the primary epileptogenic focus and its relation to functional cortical areas. The investigations include interictal and ictal extracranial (scalp) electroencephalography (EEG) and invasive methods (depth, subdural, foramen ovale electrodes and peroperative electrocorticography). If an epileptic focus is located in the anterior part of the temporal lobe by the use of scalp EEG, this is normally regarded as sufficient for an anterior lobectomy. However, because of poor spatial resolution by scalp EEG, it is difficult to separate mesial from lateral foci, identify the exact extent of posterior temporal or extra-temporal foci, identify the primary focus in patients with bilateral abnormalities and identify cases with minor scalp EEG-changes. As invasive EEG shows higher spatial resolution and gives an opportunity to evaluate functional areas, invasive EEG has significant advantages in these patients. Use of invasive EEG bears a slightly increased risk and discomfort to the patient, but is necessary in the presurgical evaluation of some patients suffering from medically intractable epilepsy.
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Affiliation(s)
- P J Jennum
- Klinisk neurofysiologisk afdeling, Hvidovre Hospital, København
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49
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Jennum PJ, Hein HO, Suadicani P, Gyntelberg F. [Cardiovascular risk factors in snorers. The Copenhagen Male Study]. Ugeskr Laeger 1993; 155:3380-4. [PMID: 8259629] [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: 01/29/2023]
Abstract
Former studies on the association between snoring and cardiovascular disease (CVD) have only partly taken established CVD risk factors into consideration. In the Copenhagen Male Study, 3323 men aged 54-74 years were classified according to self-reported snoring habits. Eleven CVD risk factors were examined. The prevalence of snoring decreased with age, with a 50% higher frequency of snorers in the youngest quintile than in the oldest, p < 0.00001. Snoring, age adjusted, was positively associated with tobacco smoking, p < 0.001, alcohol consumption p < 0.0001, body mass index (BMI), p < 0.0001, serum triglyceride level, p < 0.01, systolic blood pressure, p < 0.05 and diastolic blood pressure, p = 0.07. Snorers were less physically active in leisure time than others, p < 0.01. The association between self-reported snoring and blood pressure disappeared when other factors, including BMI, were taken into consideration. No significant associations were found between snoring and social class, snoring and low or high density lipoprotein, nor between snoring and hypertension. We conclude that snoring is associated with major cardiovascular risk factors. Accordingly, it is evident that in studies on snoring and cardiovascular disease, proper controlling for the influence of potential confounders is a sine qua non.
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Affiliation(s)
- P J Jennum
- Klinisk neurofysiologisk afdeling, Hvidovre Hospital, København
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Rabjerg L, Jennum PJ, Mørck HI. White lead exposure among Danish police officers employed in fingerprint detection. Scand J Work Environ Health 1983; 9:511-3. [PMID: 6673108 DOI: 10.5271/sjweh.2382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
White lead exposure among Danish police officers employed in fingerprint detection. Scand j work environ health 9 (1983) 511-513. White lead is often used by police officers employed in fingerprint detection (dactylography). On the basis of a case of mild lead intoxication in a police officer all 22 exposed police officers at the Bureau of Dactylographic Identification in Copenhagen were examined. All went through a clinical examination and blood lead determination. None of the participants showed any sign of lead intoxication. The median blood lead concentration was 0.97 mumol/l (10th-90th percentiles 0.72-1.44 mumol/l), a value definitely higher than the average of the general population matched for age and sex. A correlation between the weekly white lead exposure and blood lead concentration (r = 0.87, p less than 0.0001) was found among the participants.
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